The improved diagnosis in chronic cardiac failure and the lack of donor hearts have lead to a reexamination of the indications of cardiac transplantation. In the absence of a contraindication, the indication is straightforward in class IV of the NYHA to improve quality of life. In less sympatomatic patients, the primary objectives are to improve the prognosis and prevent sudden death: the indication should be considered with respect to a range of criteria (the VO2 max and arrhythmogenic potential are important features) and the rate of progression of the disease (resistance to treatment, repeated episodes of decompensation). This indication may and should be reevaluated to optimise the distribution of the race donor hearts for the benefit of patient with the most to gain.