As editors of JAMA Cardiology, we greatly respect seeking the truth, endorsing benefits, and avoiding harms. These tenets are relatively straightforward to pursue for pharmacological therapies, devices, and interventional procedures. However, health policy creates new challenges and, in the case of the 2018 United Network for Organ Sharing (UNOS) heart transplant allocation policy, new concerns. It is out of our concerns of unintended consequences that we once again both publish and opine on the early experiences with this new policy.