Background The extreme scarcity of donor hearts limits the availability of heart transplantation. Patients from vulnerable communities are disproportionately impacted. Social determinants of health (SDoH) are often quantified using place-based disadvantage indices. In this study, we apply place-based disadvantage indices and evaluate their relationship with heart transplant waitlist outcomes. Methods We studied all adult heart-only transplant candidates initially listed between January 1, 2019 and December 31, 2022. Four indicies were compared: SVM, SVI, ADI, and DCI. Covariates included demographic characteristics, VADs, total artificial heart, and initial status (1-6). The primary event of interest was heart transplantation. Candidate death or removal from the waitlist due to deterioration served as a competing event. For each index, we performed a competing risk regression with indices split by decile (categorical variable) and all covariates. We also performed competing risk regressions stratified by the transplant center where each candidate was waitlisted. Results Our final study cohort included 16,639 adult heart transplant candidates. Candidates in the 10th SVM decile were significantly less likely to receive transplantation than candidates in the 1st decile (sub-HR=0.84, p<0.001). Candidates in the 4th, 7th, and 9th SVI decile were significantly less likely to be transplanted (9th: sub-HR=0.82, p=0.034). Candidates in the 4th through 10th ADI decile were significantly less likely to be transplanted (10th: sub-HR=0.73, p<0.001). Candidates in the 3rd and 10th DCI decile were less likely to receive a transplant (10th: sub-HR=0.87, p=0.006). When stratifying by transplant center, we found that SVM decile did not significantly predict a candidate’s likelihood of receiving a transplant. For SVI, candidates in every SVI decile (2nd – 10th) were significantly less likely to receive a transplant than candidates in the 1st SVI decile (10th decile: sub-HR = 0.79, p=0.035). For ADI, candidates in the 9th decile were significantly less likely to receive a transplant than patients in the 1st ADI decile (sub-HR = 0.86, p=0.025). For DCI, candidates in the 3rd decile were significantly less likely to receive a transplant than patients in the 1st DCI decile (sub-HR = 0.91, p=0.048). Conclusion All four indices showed an association with a candidate’s likelihood of transplantation, with significant variability between the indices. These findings highlight the relationship between neighborhood vulnerability and access to transplant, and the importance of investigating more deeply how best to correct for this obstacle to equitable distribution in the forthcoming continuous distribution heart allocation framework.