Just 3 days after the first heart transplantation in Cape Town was performed by Christian Barnard in 1967, Adrian Kantrowitz carried out first heart transplantation on infant in New York. That child sufferd from Ebstein malformation, and both patients died soon after the operation. This and other unsuccessful outcomes slowed down transplantation of solid organs up until the 80s and beginning of immunosuppression, after the introduction of cyclosporine. Successful immunosuppression led to increasing number of heart transplantations in pediatric population, whis reached its peak in the 90s of about 400 cases per year reported to International Society for Heart and Lung Transplantation. More than 12 000 heart transplantations were performed in pediatric patients, until this day. Similar to the rise of the number of heart transplantations performed, improvement in survival has been observed over time. Longer survival had been achieved by development of complex guidelines for screening of donors and recipients and advancements in preoperative and postoperative patient care. Better survival rates enabled more indications for consideration for heart transplantation and reduced the number of contraindications. Development of new and complex mechanical circulatory support devices led them to be used as a successful bridge to transplantation, or as a support after the operation. Heart transplantation remains the golden standard in treatment of patients with end-stage heart failure, but longer survival opens up some new difficulties in these patients, like other organ failures, malignancies and almost inevitable graft failure and need for retransplantation. Unfortunately, lack of organ availability in relation to those in need of transplantation remains one of the main limiting factors for increasing the number of heart transplantations.