Heart transplantation is a therapeutic option for many patients with end-stage heart failure. Vigorous medical therapy has evolved so that many patients eligible for heart transplantation can now be discharged and stabilized with medical therapy. Heart transplantation improves survival, but it has not been compared previously with sustained medical therapy with regard to quality of life. We compared quality of life for 24 patients who survived at least 6 months after heart transplantation with that for 20 patients clinically similar at baseline who survived at least 6 months with sustained medical therapy. Quality of life was assessed by using three questionnaires. Both groups were similar in psychosocial functioning, with patients receiving medical therapy reporting greater dysfunction in social activities, as compared with those who underwent heart transplantation. No differences were seen in 6-minute walking distances and employment status. Survival benefits are expected with heart transplantation; however, quality of life for survivors may not be different than that for patients who survive with sustained medical therapy.