The world's first human-to-human heart transplant was performed at Groote Schuur Hospital on the 2nd December 1967. Between 1967 and 1973, 10 patients underwent orthotopic heart transplantation. Four lived for more than 1 year. The longest survivor died after 12 1/2 years, and one patient remains alive and fully employed 11 1/2 years after transplantation. Since 1974, 44 patients have undergone heterotopic heart transplantation, whereby the donor heart is inserted in parallel with the recipient's own heart. Four of these patients have undergone retransplantation for acute or chronic rejection. Survival has been almost 60% for 1 year, falling to 21% by 5 years. The major complications of heart transplantation have been early acute and late chronic rejection; immunosuppression has been complicated by a high incidence of infection, particularly during the first year, and by a 10% incidence of the development of malignant tumours. A portable hypothermic perfusion system has been developed to store and transport donor hearts for periods of up to 24 hours.