The lung has historically been the most challenging of the human organs to be successfully transplanted in clinical practice. It is possible to transplant lungs singly (SLT) or sequentially as a bilateral lung transplant (BSLT) depending on patient characteristics and the nature of the pathological lung condition present. Lung transplant assessment tests typically include sputum tests for Aspergillus and Aspergillus precipitins. Right heart catheterization is undertaken in patients considered for lung transplantation for pulmonary hypertension. Smokers and patients with a history of mild asthma may still be considered as potential lung donors. At many centers, anesthesia for sequential bilateral lung transplantation is undertaken as sequential single lung transplants to avoid the perceived increase in acute lung injury post-operatively which is said to accompany extracorporeal perfusion. Immunosuppression commences pre-operatively with the administration of azathioprine and cyclosporin A. Quality of life is significantly improved by transplantation for pulmonary failure.