Ischemic preconditioning is a phenomenon of increased tissue resistance to ischemic injury evoked by brief intermittent periods of ischemia. Since its discovery in 1986, extensive studies were undertaken to explain its mechanisms and induce protection pharmacologically. There is convincing evidence on adenosine receptors, ATP-dependent potassium channels, nitric oxide and tyrosine kinases pathways involvement in the process. Universal ability of various tissues to adopt protection from short-time ischemia and reperfusion makes clinical applications of the phenomenon, including field of transplantation medicine, highly appealing. This review summarizes known physiological pathways of ischemic preconditioning. Trials on protection against cold ischemia and other transplant-related issues of preconditioning are also presented.