It is a great pleasure for me to contribute a brief introduction to this volume, to which so many of my colleagues at Groote Schuur Hospital and the University of Cape Town Medical School have contributed. Though considerable advances have been made in preventing or treating the complications of heart transplantation, even today a transplant pro gramme remains a major undertaking for a hospital team. The acquisition of a sufficient number of donor hearts, the maintenance of viability of those hearts, and the prevention, diagnosis and treatment of acute and chronic rejection and infection remain major challenges to those caring for patients undergoing this operation. A transplant programme draws into it medical, surgical, nursing and paramedical staff from all quarters of the hospital and medical school, and requires sustained interest and dedication if patients are to be brought successfully through the procedure. If relevant experimental research is also to be carried out at such a centre, which in my opinion is essential, then an even greater number of highly skilled and creative people is required. A few of the authors of this book have been involved with the Groote Schuur heart transplant programme since its inception in December 1967 with the operation on Louis Washkansky. I am sure that none of them (nor I) had any idea of the public interest this operation would attract.