Administration of Prothrombin Complex Concentrate vs. Standard Transfusion During/After Heart Transplantation

Inclusion Criteria: * Be willing and able to provide written informed consent. * Be at least 18 years of age. * Patients with or without ventricular assist device (VAD) undergoing heart transplantation * Patients who have been on warfarin for at least 72 hours before cardiopulmonary bypass procedures for heart transplantation. * International normalization ration (INR) greater than or equal to 1.5 * Body temperature greater than 35.0 degrees Celsius. * Blood pH greater than 7.2 * Hemoglobin greater than 7.0 mg/dL. Exclusion Criteria: * Treatment with clopidogrel, prasugrel, or ticagrelor within 5 days prior to study surgery. * Known or suspected thrombophilia such as factor V Leiden, hereditary antithrombin III deficiency, heparin-induced thrombocytopenia, disseminated intravascular coagulation. * Ischemic or thromboembolic events within 6 weeks of study surgery. * Known allergy/anaphylaxis to prothrombin complex concentrate or albumin. * Any indication that a potential subject did not comprehend the study restrictions, procedures. or consequences therein an informed consent cannot be convincingly given. * Patients on respiratory support including extracorporeal membrane oxygenation (ECMO) . * Life expectancy less than 48 hours. * Excluded at the discretion of the surgeon based upon surgical safety precautions