Cardiac transplantation is now a well-accepted therapy for patients with advanced heart failure. In appropriately selected recipients, it has shown to significantly improve the survival and quality of life. The shortage of appropriate cardiac donor hearts, the costs of cardiac transplantation and its associated long-term medical follow-up, and the potential morbidity and mortality associated with the procedure and with life after transplantation mandates the judicious application of cardiac transplantation to appropriate recipients. A review of current indications, contraindications and evaluation of patients for cardiac transplantation is presented.