Cardiac transplantation has been established as a therapeutic strategy for patients with end-stage heart failure in the developed countries. In Japan, the first cardiac transplantation under the new legislation was successfully performed on February 1999 in Osaka University Hospital. Following this successful operation, the agreement with the transplantation under brain death seems to be further obtained in Japan. However, the number of the transplantation performed during the following 3 years was not enough. Thus, we wish that the number will further increase and that the transplantation will become one of the established therapeutic strategies for end-stage heart failure in our county.