Lung transplantation is an established treatment option for patients with emphysema due to chronic obstructive pulmonary disease or alpha 1-antitrypsin deficiency. Operative mortality is low in experienced centers and functional results are acceptable. Morbidity associated with triple drug immunosuppression is significant. Constant annual death rates due to obliterative bronchiolitis and other complications result in a 50% 5-year survival; therefore, lung transplantation should only be offered to those ideal candidates who have no other treatment option.