A heart transplant is a procedure in which a damaged or diseased heart is removed and replaced with a healthy one. The healthy heart comes from a deceased donor. It is the last resort for people with heart failure when all other treatments have failed. Heart failure might have been caused by coronary artery disease, damaged heart valves or heart muscles, a weakening of the heart muscle (cardiomyopathy), congenital heart defects, dangerous recurring abnormal heart rhythms (ventricular arrhythmias) not controlled by other treatments, viral infections of the heart or failure of a previous heart transplant. Although a heart transplant surgery carries many risks, the survival rate has greatly improved in recent years. Technological and pharmaceutical achievements, proper patient selection, superb medical management, meticulous operative care, vigilant surveillance and responsive long-term follow-up can all be credited for the continuing success of heart transplantation. Nowadays, there is a need to search for and understand the alternative approaches for heart failure therapy. Further advances in immunosuppression, immune tolerance and personalized medicine hold the key for future gains. The introduction of mechanical circulatory support (MCS) has largely contributed to the advancement in treatment of end stage heart failure. Also, clinical experiences have already suggested the potential therapeutic effects of stem cell therapy. Finally, whole organ engineering is on the horizon as new techniques have opened the way for this to proceed. In this paper I will present both the current state and the future of heart transplantation.