In the first year of our lung transplantation program, 211 patients with end-stage pulmonary disease were referred for consideration. Over 50 percent of the patients had chronic obstructive pulmonary disease, and almost 20 percent had idiopathic pulmonary fibrosis. The referrals were screened according to predefined criteria of eligibility for single and double lung transplantation. After screening, 46 of the referred patients were admitted for an extensive inpatient evaluation, and 18 of these were accepted as candidates for transplantation. Although interest in lung transplantation is growing in both the medical and lay communities, a significant number of patients with end-stage pulmonary disease were ineligible by our current criteria. As experience with these procedures is gained, criteria for selection may become less restrictive, and more patients may be candidates for transplantation.