During the past 30 years, cardiac transplantation has been offered as therapy for a variety of inoperable heart conditions. This therapy remains palliative, however, and a certain number of recipients will need retransplantation. The use of scarce donor organs for cardiac retransplantation is controversial; and the overall retransplantation rate varies from 2.2% to 4.4%. Common indications for retransplantation include primary graft failure, intractable rejection, and graft coronary artery disease. Emergency retransplantation for rejection or acute graft failure is associated with poor results. In carefully selected patients, especially recipients with graft coronary artery disease, the outcome of elective retransplantation is comparable to that of primary transplantation. Cardiac retransplantation is a feasible and rational therapy with good results when applied to low-risk candidates.