Clinical cardiac transplantation was successfully introduced 26 years ago, and from an initial experimental status, it has moved forward to become an accepted and well-established treatment modality for end-stage cardiac disease. The first cardiac transplant operation in Hawaii was performed in March 1987; the patient lived for 1 year. A total of 20 heart transplant operations have been performed in 19 patients at St. Francis Medical Center in Honolulu. There has been only one hospital death, and our current one-year survival is 77%, which is similar to national statistics. Our longest survivor is now more than 6 years following transplantation. The incidence of rejection episodes and infectious complications is comparable to other studies.