Heart transplantation is a gold standard for end-stage heart failure, providing better patient survival and quality of life. The first successful heart transplant in Australia was performed by Dr Victor Chang at St Vincent’s Hospital in Sydney in 1984, laying the beginning of a transformative era in cardiac surgery. Over the next decades, researchers around the globe joined hands to improve heart transplantation by refining different surgical procedures. For instance, the introduction of immunosuppression agents, like Cyclosporine, significantly minimises rejection. Bicaval anastomosis lowers the risk of atrial arrhythmias, reducing the need for postoperative pacemakers. Left ventricular assist devices and total artificial hearts provide mechanical circulation and act as a stepping stone to transplantation. In 2014, a major breakthrough in heart transplantation was achieved by Australian surgeons who pioneered the use of Donation after Cardiac Death (DCD) hearts with ex vivo perfusion and completed the first DCD heart transplant in the world. This would not have been possible without the machine “Heart in a box”, which was invented by Professor Peter MacDonald and his team. In the past, transplant units relied exclusively on functioning hearts which were from brain-dead patients. Therefore, this groundbreaking approach greatly expanded the donor pool and increased transplant opportunities. It also acted as a paradigm of heart transplant, setting new standards worldwide. The rich history of heart transplantation in Australia has served as a cornerstone of innovation, shaping the future of global transplant practices. Ref: The Victor Chang Cardiac Research Institute, 2024, Heart Transplantation. https://www.victorchang.edu.au/heart-transplant.