Heart transplantation is a life- saving and quality of life enhancing treatment option for patients with end- stage heart failure. Patients who are suitable candidates suffer from a terminal illness with prognosis of 1- year survival without transplantation less than 50%. The major limiting factor is donor organ availability, therefore it is important to choose recipients who are most likely to achieve long- term benefits and who tried other medical and surgical alternatives which did not work. Allocation of donor organs depends on recipient’s priority status, which is determined by strict criteria. Both donor and recipient must be thoroughly evaluated to rule out any contraindications that might prevent them from proceeding to the surgery. Only a good match between donor organ and recipient leads to a good short- term and long- term outcome of transplantation. Decades of surgical technique improvements, effective immunosuppressive agents and development of medicine in general, which supports patients’ preoperative and postoperative care, made heart transplantation a very successful treatment option with a very low perioperative mortality rate. The causes of early allograft failure are myocardial dysfunction due to donor instability, pulmonary hypertension, ischemic injury during preservation and sometimes acute rejection. Long- term complications which often tend to also become the cause of death are infections, allograft rejection, cardiac allograft vasculopathy and renal dysfunction. Chronic immunosuppression is associated with increased incidence of cancers, mostly lymphoproliferative disorders and skin cancer. Out of all complications, infection is the leading cause of morbidity and mortality. This study showed that in Clinical Hospital Dubrava, post heart transplantation survival rates at 1, 5, and 10 years were comparable to those reported by the International Society of Heart and Lung Transplantation (ISHLT).