The Organ Transplantation Act of Japan was amended in 2010. Consequently, the number of patients undergoing organ transplantations from brain-dead donors and left ventricular assist device (LVAD) implantation is increasing simultaneously. Randomized evaluation of mechanical assistance for the treatment of congestive heart failure (REMATCH) trial revealed the effectiveness of LVAD for end-stage heart failure, which also accelerates the implants of LVAD. In Japan, fewer patients undergo heart transplantation compared with those in the United States or European countries, and the waiting period for heart transplantation in Japan is far longer than that in the United States (960 days vs. 56 days). However, no definitive guidelines for managing such patients have been published yet. We attempted to provide an outline of LVAD (indication, devices, pre- and postoperative management including long-term outcomes) from our experiences and previously published articles.