Donor heart from a 6-year-old donor for a 5-year-old recipient! How precious and unique. Pediatric heart transplantation represents a small (14%) but very important and particular part in the field of cardiac transplantation. This treatment has lifelong impact on children. To achieve the best short and especially long-term survival with adequate quality of life, which is of crucial importance for this young patient population. The differences in anatomy and physiology make the surgical procedure much more complex and create unique challenges. Most patients are suffering from end-stage heart failure due to congenital heart disease, and the failing heart may be treated for a short period of time by medications, but in the absence of other correctable diseases without either replacing the heart (heart transplantation) or mechanical circulatory support, the destiny of the patient will take a fatal run. Transplantation is considered to be the “golden standard” for patients, both adults and children, suffering from end stage heart failure.