Objective: To examine symptom frequency and distress in heart transplant candidates. Design: Prospective, two-site study with a correlational design. Setting: Large Midwestern and large Southern medical center. Sample: Convenience sample of 175 adult patients (mean age 52 years, 85% men) awaiting heart transplantation. Fifty percent of the patients had ischemic cardiomyopathy and 47% had dilated cardiomyopathy. Instruments: The Heart Transplant Symptom Checklist (Grady, Jalowiec, and Grusk, 1988), a 92-item self-administered instrument that measures how much patients are bothered by symptoms on a four-point rating scale, was developed by the research team for the study. Cronbach alpha reliability for the total scale was 0.95. Results: The most frequent and distressing symptoms for patients awaiting heart transplantation were tiredness, difficulty breathing when walking or doing something, difficulty sleeping, and weakness in the whole body. Patients who had more symptom distress were unable to work. Higher symptom distress correlated significantly with higher stress, less life satisfaction, lower quality of life, and more functional disability. Summary: Heart transplant candidates experience symptoms that may affect their ability to work and are associated with more functional disability and lower quality of life. Implications: Identification of the most frequent and distressing symptoms helps nurses and other health care providers to better assess and intervene with patients who are heart transplant candidates.