Because of the high prevalence of clinically silent cardiovascular disease and increased incidence of adverse cardiovascular events in transplant recipients, cardiovascular evaluation before transplantation is critical. The standard non-invasive screening tests for evaluating coronary artery disease include dobutamine stress echocardiogram and myocardial perfusion image (adenosine, dipyridamole nuclear scintigraphy). The optimal non-invasive screening test is unclear, with the optimal choice based upon the expertise of the particular medical center. The practitioner is advised to view current guidelines as recommendations rather than as strict rules and to combine them with clinical judgments. In addition, excessive reliance on noninvasive tests that are not sufficiently accurate to exclude significant coronary artery disease in high-risk candidates may engender a false sense of security.