Introduction and objectives. The purpose of this article was to present the results of the heart transplantations carried out in Spain from the first use of this therapeutic modality in May 1984. Methods. A descriptive analysis of all heart transplantations performed up until December 31, 2008 was carried out. Results. In total, 5774 transplantations were performed. The typical clinical profile of a Spanish heart transplant patient in 2008 was that of a 53-year-old male who had been diagnosed with nonrevascularizable ischemic heart disease and who had severely depressed ventricular function and a poor functional status. The implanted heart typically came from a 37-year-old donor who had died from a head injury or brain hemorrhage and the average waiting time was 111 days. The mean survival time has increased progressively over the years. Whereas the probability of survival at 1, 5, 10 and 15 years for the whole patient series was 77%, 66%, 53% and 40%, respectively, the probability of survival at 1 and 5 years for patients seen in the last 5 years was 80% and 70%, respectively. The most frequent cause of death was infection (17%), followed by the combination of graft vascular disease and sudden death (15%), acute graft failure (13%), tumors (12%), and acute rejection (6%). Conclusions. The survival rate obtained with heart transplantation in Spain, especially in recent years, has made transplantation the treatment of choice for patients with end-stage heart failure and a poor functional status and for whom there are few other established medical or surgical options.