Heart-lung transplantation is associated with high perioperative mortality rates. A modified operative technique was used by one surgeon operating on 17 patients at the University of Arizona, Tucson, and the Inland Northwest Thoracic Organ Transplant Program, Spokane, Washington. This technique gives greater exposure to the area of dissection behind the heart-lung block after implantation and makes maintaining hemostasis easier. No deaths from bleeding complications occurred and no reoperations for bleeding were required with this technique. The Kaplan-Meier survival was 82% at 1 year. This technique simplifies a difficult technical procedure and may reduce mortality rate.