The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) does not specifically address how to rate heart transplants, but by applying principles used in rating similar illnesses, the evaluator can assess permanent impairment. The fourth and fifth editions of the AMA Guides contained directions for rating impairment created by a heart transplantation. Since these editions appeared, more heart, kidney, lungs, hands, and even faces have been transplanted. The AMA Guides, Sixth Edition, provides guidance only on rating individuals who received a kidney transplant, but this article describes a method for rating individuals following cardiac transplant and using principles in the cardiovascular chapter in the sixth edition of the AMA Guides. The steps are as follows: 1) rate using Table 4-7 Criteria for Rating Impairment due to Cardiomyopathies; 2) use classes 2, 3, or 4 for rating the posttransplant individual; 3) an individual who is posttransplant with totally normal cardiac physiological function is rated as class 2, level A; 4) combine with the burden of treatment compliance impairment caused by antirejection medications; and 5) combine with impairment found in any other organ system resulting from medications used to treat the heart, infections, and rejection. This article shows that if a specific, medically documented injury or illness is not addressed in the AMA Guides, the evaluator can apply the rating principles used in rating similar conditions in order to determine impairment.