Although many problems remain, cardiac transplantation is now associated with a 5 year survival rate of about 70 per cent which is a very acceptable therapeutic result in patients with cardiac failure and no other medical or surgical alternative. Parallel improvement in the medical management of chronic cardiac failure has prolonged survival of many patients. Transplantation should only be considered if the benefits not only in terms of survival but also in terms of quality of life, are greater than of survival but also in terms of quality of life, are greater than those of medical treatment of the cardiac disease. The indications and timing of cardiac transplantation are therefore based on a complex prognostic evaluation adapted to each individual case which may eventually need reconsideration. Satisfactory results depend on strict patient selection with respect for the surgical indications and contra-indications.