Cardiac transplantation, once considered an experimental procedure, has emerged as the therapy of choice for many appropriately selected patients with life-threatening irremediable heart disease. Congestive heart failure (CHF), the primary indication for cardiac transplantation, is the most commonly reported reason for hospital admission. A knowledge of cardiac transplantation medicine is therefore important for all physicians, as transplantation should be considered a therapeutic option for many of these patients. In the past, post-cardiac transplant care was largely performed by specialized transplant physicians, primarily cardiologists and cardiovascular surgeons. As survival after cardiac transplantation has improved markedly over the last decade, the population of patients who are long-term survivors after heart transplantation has grown. Primary care physicians, as well as cardiologists not based at cardiac transplant centres, often assist in the care of these patients, most often in consultation with cardiac transplant physicians. In addition, a physician may be called on to assist in the management and evaluation of a potential cardiac donor.