It has been 40 years since the first human-to-human heart transplant performed 
in South Africa by Christiaan Barnard in December 1967. This achievement did not 
come as a surprise to the medical community but was the result of many years of 
early pioneering experimental work by Alexis Carrel, Frank Mann, Norman Shumway, 
and Richard Lower. Since then, refinement of donor and recipient selection 
methods, better donor heart management, and advances in immunosuppression have 
significantly improved survival. In this article, we hope to give a perspective 
on the changing face of heart transplantation. Topics that will be covered in 
this review include the changing patient population as well as recent advances 
in transplantation immunology, organ preservation, allograft vasculopathy, and 
immune tolerance.