**1. Introduction**

Heart transplantation has emerged as a lifesaving treatment for end-stage heart failure patients worldwide [1]. Despite the successful outcomes achieved by established heart transplantation programs, many regions, including Middle East countries, lack comprehensive programs for this critical intervention. This chapter will focus on providing an in-depth analysis of the necessary requirements and logistical considerations to establish a heart transplantation program in a Middle East country, with an emphasis on the unique challenges and strategies specific to the region.


#### **Table 1.**

*History of cardiac transplantation in middle east region.*

Before we start, it is important to have a vision of the history of heart transplantation in Middle East counties.

Middle East, the lands around the southern and eastern shores of the Mediterranean Sea, encompassing at least the Arabian Peninsula and, by some definitions, Iran, North Africa, and sometimes beyond [2]. According to the published literature regarding the countries providing heart transplant services in Middle East, few countries have this modality of treatment (**Table 1**). In fact, this shows how important it is to work to find new centers and transfer the service to countries that have not yet started the heart transplant program.
