Donor to recipient matching is based primarily on ABO blood group compatibility. Median sternotomy is the standard approach for heart transplantation. Although the surgical technique of heart transplantation is simple, there are certain specific circumstances in which the operation can be technically demanding and require careful planning to get the best outcome. Ventricular assist devices (VADs) are more commonly used as a bridge to transplantation, and many patients wait for heart transplantation with a functioning VAD or are listed for urgent procedure due to VAD-related complications. Heart-lung transplantation and domino heart transplantation have largely been superseded by bilateral sequential lung transplantation. Heterotopic transplantation allows much more leniency on the donor and recipient mismatching. Careful consideration should be given to the adequacy of cardiac output in maintaining oxygen delivery to the tissues, bleeding, collections, pneumothorax, and position of the monitoring lines.