Over a decade has passed since the first successful neonatal heart transplant was performed for palliation of hypoplastic left heart syndrome. Although neonates and infants represent a growing group of pediatric heart transplant recipients, survival remains inferior to that in older children. Decisions regarding transplantation in infancy pose unique problems for the pediatric cardiologist, including limited donor availability, pre-and posttransplant management, and improving results of alternative palliative surgery for hypoplastic left heart syndrome. A number of recent articles provide important information about donor availability, waiting times to transplantation, and outcome after listing and transplantation. Other studies focus on the treatment of infants awaiting transplantation. Important laboratory investigations reported this year focus on strategies for inducing immunologic tolerance (the “Holy Grail” of the transplant physician) as well as ongoing research in the controversial area of xenotransplantation.