The first human-to-human heart transplant was performed 50 years ago in 1967. 
Heart transplantation has now entered an era of tremendous growth and 
innovation. The future of heart transplantation is bright with the advent of 
newer immunosuppressive medications and strategies that may even result in 
tolerance. Much of this progress in heart transplant medicine is predicated on a 
better understanding of acute and chronic rejection pathways through basic 
science studies. The future will also include personalized medicine where 
genomics and molecular science will dictate customized treatment for optimal 
outcomes. The introduction of mechanical circulatory support (MCS) devices has 
changed the landscape for patients with severe heart failure to stabilize the 
most ill patient and make them better candidates for heart transplant. As ex 
vivo preservation takes hold, we may witness an expansion of the donor pool 
through the use of donation after cardiac death (DCD) donors. In addition, 
further geographical donor heart sharing through ex vivo preservation may 
further decrease waitlist mortality by enabling longer distance donor hearts to 
be allocated for the sickest waitlist patient. It is no doubt an exciting time 
to be involved in the field of heart transplantation. In this perspective, we 
will summarize the present state of heart transplantation and discuss various 
innovations that are being pursued.