This report describes the general characteristics and outcomes of heart transplantation in Spain after data from 2002 were added to the registry. In 2002, 310 heart transplantations were performed. Since 1984, a total of 4,096 procedures have been performed. The average clinical profile of patients receiving a heart transplant in Spain is that of a man about 50 years old, blood group A, with nonrevascularizable coronary artery disease and functional status IV/IV (NYHA). The percentage of emergency heart transplantations was 26%, which is higher than the previous year (19%) and the mean for the preceding five years (22%). The early mortality rate was 10%, which is significantly lower than the mean for the preceding five years (14%). After combining the 2002 results with those of previous years, an increase in survival rate was seen. Thus, the probability of survival in the first, fifth and tenth years was 76%, 66%, and 54%, respectively. When survival rates for separate periods were considered, a clear improvement was seen from the first year (80%) to the fifth year (72%). The most frequent causes of death were acute graft failure in the first month, infection and rejection in the first year, and tumors and the combination of vascular disease of the graft with sudden death in the long term. Comparative analysis of survival rates shows that our long-term results are slightly better than those published worldwide, with a clear tendency for survival rate to improve as a consequence of the experience acquired in all stages of this cross-disciplinary procedure.