Over the last two decades, lung transplantation has evolved from experimental to a definite therapy for a variety of end stage lung disorders. This can be attributed to the development of better immunosuppression, better graft preservation, and refinement in the operative techniques. Techniques have been developed to accommodate anomalous donor anatomy, suboptimal harvests, and to increase the donor pool. Recipient pneumonectomy and allograft implantation techniques have evolved to minimize periopertive morbidity and mortality. However, a numver of major problems await solution; for example, inadequate donor supply, ischemia-reperfusion injury, and chronic allograft rejection. Novel therapies are being investigated based on experimental studies; however, multiinstitution trials will be required to determine the clinical impact of these strategies.