Both the prevalence and incidence of heart failure are high in developed countries. The number of patients suffering from the condition is continuing to grow as life-expectancy increases and, consequently, the population ages. In Spain, the number of deaths due to heart failure is similar to that due to cancer. Various treatments for heart failure, including specific drugs, implantable devices (i.e. cardioverters and defibrillators) and temporary or permanent ventricular assist devices, have been shown to improve survival and are now used regularly. Nevertheless, some patients with heart failure, though small in number, will benefit from heart transplantation. The procedure clearly improves quality of life and prolongs survival for many years. However, heart transplantation is not a routine procedure. It can result in a variety of problems, most of which must be tackled using a multidisciplinary approach. The aim of this update was to provide a broad overview of current practices employed by heart transplantation teams in Spain.