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Fewer post-transplant deaths occurred in the hospital (22%). Out-of-hospital death was associated with older patient age (p.01). ICU deaths with high use of technological interventions at end-of-life were common, particularly in patients awaiting heart transplant. In this high mortality population, findings raise challenging considerations for clinicians, families, and policy makers on how to balance quality of life amidst high risk for hospital-based death. ICU deaths with high use of technological interventions at end-of-life wer