During the past 17 years, cardiac transplantation has evolved from experimentation to reliable clinical application. Advances in this field have paralleled progress in cardiovascular surgery and in other branches of medicine. Technical aspects of donor procurement and recipient operation are outlined. Introduction of cyclosporine has been associated with improved results, but adverse side effects associated with this drug have prompted introduction of lower-dose cyclosporine regimens. Infection and rejection remain the most common and difficult complications after cardiac transplantation. Current survival exceeds 80% at one year, and more than 80% of one year survivors can be expected to be fully rehabilitated. Continuing research will focus upon improved control of the immune response and wider application of transplantation techniques.