Recently published studies have improved our understanding of the wide array of issues involved in cardiac transplantation. Organ implantation using a bicaval technique is the preferred method at most centers and may improve survival. Preoperative recipient risk factors such as pulmonary hypertension, morbid obesity, certain psychiatric disorders, and advanced age may not preclude successful transplantation. Conversely, poor compliance with medication, depression, and post traumatic stress disorder following transplantation were independent predictors of acute rejection, graft coronary disease, and mortality. Large randomized studies have reported similar survival following transplantation with Neoral (Sandoz, East Hanover, NJ, USA) compared with the Sandimmune (Sandoz, East Hanover, NJ, USA) formulation of cyclosporine. The patients receiving Neoral, however, experienced fewer infections and milder episodes of rejection. Mycophenolate mofetil significantly improved 3-year survival following heart transplantation, compared with azathioprine. Although progress is being made in cardiac transplantation, a key impediment in this field remains the shortage of donor organs.