The technique of heart transplantation was described by Lower and Shumway in 1961 and has been continuously developed. After the first heart transplantation in humans on December 3, 1967, performed by Professor Christian Barnard, more than 100 heart transplants were performed worldwide in 1968. Regrettably, postoperative mortality was very high due to natural rejection reactions. Only after the invention of Cyclosporin A were long-term successes achieved in the 1980s. Currently, about half of all transplant recipients survive more than 13 years, and the proportion of patients who live longer than 20 years after transplantation is increasing. Due to the increasing shortage of donor organs, there was a growing discrepancy between organ demand and organ availability around the turn of the century. Despite various strategies to expand the organ pool, only 327 isolated heart transplants could be performed in Germany in 2020 ( http://www.eurotransplant.org ).