Cardiac transplantation can be a breakthrough in the life of those with end-stage heart failure. However, starting complicated operations such as transplantation has a learning curve and accordingly, considerable morbidity and mortality for the initial cases are expectable. Since 2006, cardiac transplantation was started at the Masih Daneshvari Medical Center. The first few operations were performed under the support and assistance of experts from two other centers with considerable experience in heart transplantation. Case selection was mainly based on consensus building. According to the experience of the two older and more experienced centers of heart transplantation, we organized an integrated team consisting of specialists in nephrology, infectious disease, pulmonology, clinical pharmacology, immunology, physiotherapy, physical therapy, psychology, radiology, and pathology for cardiac transplantation. 15 patients have so far undergone cardiac transplantation, eleven of which are alive and functionally active. Regular follow-up of these patients has been associated with favorable outcomes; so far there are no cases of severe rejection or graft vasculopathy. Mortalities were mainly attributable to inappropriate case selection. Two patients died at the operating room and the remaining two succumbed to in-hospital refractory heart failure. IN conclusion, the initial results have been promising, mostly thanks to the appreciable teamwork of the group as well as the surgeons’ close cooperation and support provided by other experts. Our early experience, including case selection and follow-up process was mainly based upon consensus and partly biased. We have been recently working to devise a comprehensive and applicable protocol so that our future results will be reproducible, more desirable, and statistically meaningful.