Background: Little is known about the psychological challenges facing patients’ post-heart transplant surgery. Whilst the research indicates an increase in mental health problems, we have no real information on the role of related contributing psychological factors. Objective: This paper aims to build upon our understanding of existing research and highlight themes facing this patient group to raise awareness in health teams and to support a more tailored psychological intervention. Method: It uses conductive research to analyse available research and additionally presents thematic clinical observations, reflecting additional experiences noted by the author during her own therapeutic practice with transplant patients. Results: The findings reflect a dual illness trajectory with psychological concerns existing alongside and beyond the physical recovery period. Conclusions: Recommendations are made to support healthcare colleagues to facilitate the care offered to this group of patients using the information presented. What is already known about this topic: Little is known about this topic beyond prevalence studies and a few studies establishing generic links between mental health, quality of life and transplant recovery. What does this article add: The paper moves the existing research forward by giving more specific information on potential issues for these patients as a sub section of adjustment research above - building on the broader categories already in place. The information can be used at an individual clinical level but also to introduce to the wider system when offering treatment to this group of patients with the relevant model suggested.