Little is known regarding the profile of patients with multiorgan failure listed for simultaneous cardiac transplantation and secondary organ. In addition, few studies have reported how these patients are bridged with mechanical circulatory support (MCS). In this study, we examined national data of patients listed for multiorgan transplantation and their outcomes after bridging with or without MCS. United Network for Organ Sharing data were reviewed for adult multiorgan transplantations from 1986 to 2019. Post-transplant patients and total waitlist listings were examined and stratified according to MCS status. Survival was assessed via Cox regression in the post-transplant cohort and Fine–Gray competing risk regression with transplantation as a competing risk in the waitlist cohort. There were 4534 waitlist patients for multiorgan transplant during the study period, of whom 2117 received multiorgan transplants. There was no significant difference in post-transplant survival between the MCS types and those without MCS in the whole cohort and heart-kidney subgroup. Fine–Gray competing risk regression showed that patients bridged with extracorporeal membrane oxygenation had significantly greater waitlist mortality compared with those without MCS when controlling for preoperative characteristics (subdistribution hazard ratio, 2.27; 95% confidence interval, 1.48-3.47; P < .001), whereas those bridged with a ventricular assist device had a decreased incidence of death compared with those without MCS (subdistribution hazard ratio, 0.78; 95% confidence interval, 0.63-0.96; P = .017). MCS, as currently applied, does not appear to compromise the survival of multiorgan heart transplant patients. Waitlist data show that extracorporeal membrane oxygenation patients have profoundly worse survival irrespective of preoperative factors including organ type listed. Survival on the waitlist for multiorgan transplant has improved across device eras. Cumulative incidence curves (upper panel) that depict an increased incidence of death in patients who received extracorporeal membrane oxygenation (ECMO) while waitlisted for multiorgan transplantation. Curves were produced using Fine–Gray competing risk regression with transplantation as a competing risk. Patients were censored at the time of waitlist removal. Differences in incidence of death between mechanical circulatory support (MCS) types were assessed using the Gray test. The lower panel depicts adjusted survival curves on the basis of a Cox proportional hazards analysis that shows that there was no survival difference between patients bridged to multiorgan transplant with each MCS type and no MCS. This study suggests that ECMO is associated with increased waitlist mortality and the use of MCS bridging should not preclude patients from receiving multiorgan transplants because survival after transplantation does not appear to be compromised by its use. IABP, Intra-aortic balloon pump; TAH, total artificial heart; VAD, ventricular assist device. Display omitted