This is a concise review of up-to-date concepts and techniques in the discipline of heart transplantation. It is a review and reference for practitioners managing patients with advanced heart disease, including patients with end-stage heart failure, mechanical circulatory support or transplant recipients. Heart failure is a major public health issue, with a prevalence of over 5.8 million in the USA, and over 23 million worldwide, and rising. The lifetime risk of developing heart failure is one in five. Heart failure carries substantial morbidity and mortality, with 5-year mortality that rival those of many cancers. As heart transplantation remains the best treatment option for patients with end stage heart failure, this primer will provide valuable information and management strategies for physicians caring for these patients. Also, due to continued shortage in donor organs, heart transplantation is a limited resource - which further underscores the importance of appropriately evaluating patients for transplant candidacy and managing their pre, peri- and post-transplant care for maximum benefit and best outcomes.