The variety and complexity of therapeutic options available for the increasing number of patients with advanced chronic heart failure has lead to the institution of specialized heart failure/heart transplant programs. The central task consists of carefully evaluating and selecting potential transplant recipients, based on the comparative benefit rationale, i.e. the expected gain in life expectancy and quality of life by cardiac transplantation compared with all other treatment options. Further tasks include a comprehensive chronic heart failure management, high risk conventional cardiac surgery, mechanical and antiarrhythmic bridging and dedicated posttransplant care. This concept is described on the basis of the 5-year experience of the Interdisciplinary Heart Failure and Transplant Program Münster.