General overview of lung transplantation and review of organ allocation.

Lung transplantation is an established treatment option for patients with a wide variety of end-stage lung diseases. For patients with end-stage lung disease, lung transplant can prolong life substantially; however, the survival statistics for lung transplants still pale compared with other solid organ transplants. Acute cellular rejection (ACR) is common after lung transplantation occurring in up to 90 percent of patients. Chronic allograft rejection, manifest as bronchiolitis obliterans syndrome (BOS), remains the "Achilles heel" to the long-term success of lung transplantation. Unfortunately, BOS is common after lung transplantation, occurring in a majority of patients by 5 years after transplant. Candidates for lung transplantation should have near-end-stage lung disease with a limited life expectancy. Allocation of organs today is based upon need and survivability of the operation, and there is a high likelihood of improvement in quality of life. Details of the advances in this fascinating field are included in the several articles in this issue.