The nature and quality of heart recipients' adaptation to transplant must be considered when evaluating the costs of utilizing this procedure. Little is known about the occurrence of clinically significant levels of psychiatric distress or other physical functional and psychosocial limitations in the long‐term following initial recovery. Most important, despite assertions that recipients' well‐being and psychosocial status are critical predictors of their medical compliance and hence, of the ultimate survival, systematic research to document such relationships is lacking. This article summarizes research on quality of life and medical compliance in transplantation, presents a conceptual framework for understanding interrelationships among such variables, and describes early results from a longitudinal study of heart transplant recipients followed during their first year after surgery. Findings indicated that psychological distress and psychosocial status early posttransplant predicted compliance levels in ensuing months; difficulties adhering to the medical regimen were, in turn, related to physical, mental, and social well‐being at subsequent follow‐up. Implications of these patterns of reciprocal effects are considered both for treatment and for refining conceptual models of adaptation to transpla