Between Jan. 1, 1977 and Sept. 15, 1978, 39 cardiac transplants were performed on 38 patients. Donor hearts (20) were removed at one hospital and 19 donor hearts were removed at distant hospitals. The characteristics of recipients and donors in both groups were similar. The only significant difference between donor hearts was the mean ischemia time (154 .+-. 30 min in distant hearts and 52 .+-. 12 min in local hearts, P < 0.001). As of Feb. 1, 1979, the total mortality rate was 32% for the distant heart donors and 40% for the local heart donors. No difference between the 2 groups was present in immediate myocardial function, the need for postoperative inotropic support, the mortality rate within the first 90 days after operation, the mean maximum serum enzyme levels, the occurrence of rejection or infection and the histological appearance of the hearts, both early and late. The results of cardiac transplantation when hearts are removed at distant hospitals are entirely comparable to the results with hearts removed on site with a minimum ischemic time. Distant heart procurement provides an expanded donor pool for potential cardiac recipients.