There is little debate about the rationale for denying heart transplantation (TX) to patients who meet DSM-IV criteria and who continue to abuse alcohol or drugs. Published statistics indicate there is an acceptably low risk of substance abuse/dependence (S A/D) relapse, with statistically similar survival rates in candidates and recipients who remain abstinent from alcohol and drugs, complete recommended treatment, and participate in needed psychological treatment as compared to recipients with no history S A/D. The purposes of this study were to report the increased incidence of methamphetamine abuse in patients with reported idiopathic heart disease in the past two-years at a major Midwestern (U.S.A.) multi-organ TX program, and the inability of those patients to meet treatment and abstinence guidelines. In the past two years: 23% (42/182) of patients referred for heart TX had a diagnosis of idiopathic disease and the incidence of methamphetamine induced cardiomyopathy increased from 30% (6/20, May 2002-April 2003), to 45% (10/22, May 2003-April 2004). Only 6% (1/16) of the patients attended treatment and remained abstinent compared to 80% (16/20) of those with other forms of S A/D who met the treatment and abstinence guidelines (confirmed by random urine toxicology) and became viable TX candidates during the same time-frame. We conclude that: (i) people who abuse methamphetamines exhibit addiction problems that have not shown to be amenable to any form of available S A/D treatment, (ii) when compared to other forms of S A/D such patients are less likely to remain abstinent pre or post-TX, and (iii) such a poor treatment response casts doubt on the appropriateness of whether such patients should be TX for humanitarian purposes.