Cardiac transplantation has now evolved from an experimental procedure to a therapeutic modality accepted by the medical community, the general public and insurance companies. A sustained improvement in the results of cardiac transplantation has occurred over the last 17 years so that 1-year survival is now 84% with a 4-year survival of 66%. As well as an increase in longevity it is important to note that 80% of survivors of heart transplantation are well rehabilitated as judged by their ability to chose the lifestyle of their choice. Most patients are able to return to work and lead an entirely nomal life except, of course, that they require to be on medication for life. The introduction of ciclosporin has not only enabled substantial improvement in the results of heart transplantation but has allowed the initiation of successful heart-lung transplantation. Future prospects include the development of improved immunosuppressive agents, the more widespread application of heart-lung transplantation, and the possibility of xenograft transplantation. In the future many patients with terminal heart disease with a deteriorating course will be salvaged by the use of left ventricular assist devices as a bridge to transplantation until a donor heart becomes available.