BACKGROUND: From 2007, the Federal Aviation Administration (FAA) permitted pilots who have had a heart transplant to be considered for recertification under special issuance at the third-class level. The objective of this study was to evaluate certification safety and determine if any adverse outcome occurred in this airman group as a consequence of this policy.METHODS: Methods involved collecting data from the FAA Document Imaging Workflow System to identify airmen undergoing cardiac transplantation since 2007, and examining medical and safety-related outcomes through the National Transportation Safety Board-related accident database and the Centers for Disease Control and Prevention National Death Index.RESULTS: Included in the study were 36 airmen, with 16 recertified at the class 3 level and 20 denied certification. No aviation accidents or recorded deaths occurred in the group of 16 airmen undergoing recertification. Of these airmen, 13 underwent a second successful recertification and 6 underwent a third attempt, with 5 being successful. Two airmen have declared their intention to fly under BasicMed. Of the 20 airmen denied recertification, 16 were denied for failure to provide information. There were three deaths in this denied group.DISCUSSION: The policy allowing third-class heart transplant recipient recertification appears to be safe. Aviation safety is not being compromised by allowing these airmen to resume flying, with the exception that recertification should continue under the special issuance system and not through BasicMed.Norris A, Skaggs V, Kaye D, De Voll J, McGiffin D. Selective recertification of pilots who have undergone a cardiac transplant. Aerosp Med Hum Perform. 2020; 91(9):732736.