Heart transplantation is a «gold standard» in the treatment of end-stage heart failure if optimal drug therapy is ineffective and reconstructive surgery is impossible. Heart transplantation increases survival of patients with refractory heart failure, improves their quality of life and ensured active life in most patients. According to recent data of the International Registry, over 5.000 heart transplantations were performed in 2017. Annual, 5- and 10-year survival after heart transplantation is 88, 74 and 55%, respectively. Heart transplantation program in health care system of the Moscow region was initiated at the Vladimirsky Moscow Regional Research Clinical Institute in 2019. Completion of all organizational and logistic procedures was followed by selection of recipients to form a waiting list. The authors report initial experience of heart transplantation in health care system of the Moscow region.