During the 22 years since Barnard’s historic operation, numerous clinical studies and advancements in basic science research have allowed significant breakthroughs in cardiothoracic organ transplantation. As experience with heart transplantation grew, surgical options for patients with high pulmonary vascular resistance and right ventricular failure were being investigated. In 1981, the Stanford group successfully performed the first combined heart and lung transplantation.’ The patient with end-stage pulmonary disease and normal cardiac function presents thoracic surgeons with a different set of challenges. The first human lung transplant was performed by Hardy et al in 1963.2 During the following 20 years, approximately 50 lung transplant operations were performed, the longest patient survival being 8 months.3 Because of this poor long-term survival rate, lung transplantation was performed only rarely until the mid-1980s. With the