Purpose of Review <p>There are specialised heart populations of macrophages that arise from diverse origins in vivo. Incorporating these into human pluripotent derived cardiac organoids (hCOs) provides a new method to study their role in cardiac function and disease. Herein, we review this topic and propose future directions.</p> Recent Findings <p>Macrophages are particularly important and exert positive and negative influences during the pathogenesis of disease, and resolution after injury. The heart microenvironment imprints specific functions into cardiac macrophages including efferocytosis of mitochrondria, control of electrical conduction and control of stromal and parenchymal homeostasis in the heart. Initial studies using hCOs has shown that incorporating macrophages improves maturation and disease modelling.</p> Summary <p>We highlight key in vivo functions have been shown by macrophages in hCOs. However, outstanding questions remain and represent exciting research avenues in the future. An important avenue being incorporation of the macrophage phenotypic diversity recently shown in vivo.</p>