This paper is based upon our experience as a psychosocial team working on the paediatric heart/heart-lung (H/HLT) programme for the last 10 years. During this time more than 350 children have been assessed, 240 have been put onto an active waiting list and 160 have had transplants. The essence of this paper is a detailed description of the multidisciplinary and comprehensive approach to children who are being considered for heart or heart-lung transplantation, and their families. The key issues of which we have become aware are: creating a therapeutic alliance; listening to and involving the children; involving the wider network; understanding the family's illness narrative and their individual belief systems, including issues of culture, ethnicity and spirituality; acknowledging and addressing the power imbalance between the child/family and professional. (Int J Psych Clin Pract 2000; 4:93-99).