Lung transplantation is a well accepted and an established treatment option for patients with a wide variety of end-stage lung diseases. The transplantation can be unilateral, bilateral, heart-lung, living donor lobe transplantation. Selection of appropriate recipient for lung transplantation is the most vital factor that determines the outcome of the procedure. Gender does not have an obvious impact on long-term outcome of lung transplantation. Generally accepted donor criteria include donor aged less than 55 years. Attempts are often made to match the age of the donor with the age of the recipient. The key to successful lung transplantation has been pharmacological immune suppression. Almost all lung transplantation centers use three-drug regimens including a calcineurin inhibitor, cell cycle inhibitor and steroids. Acute cellular rejection (ACR), occurs in up to 90% of patients and is most likely to occur during the initial few weeks of lung transplantation. Chronic rejection is the leading cause of long-term morbidity and mortality in lung transplant recipients. Viral, fungal, bacterial infections are major cause of morbidity and mortality. Neoplastic complications are also common. Donor shortage is a major concern and there is a significant discrepancy between supply and demand of lung allografts.