Bilateral lung transplantation (BLT) has evolved into a routine procedure and is the most frequently performed method. Traditionally single lung transplantation (SLT) has been the procedure of choice in patients with non-infective end-stage lung disease such as chronic obstructive pulmonary disorder (COPD) and idiopathic pulmonary fibrosis (IPF). Most common incisions for SLT are the posterolateral thoracotomy, anterolateral thoracotomy and median sternotomy, which are usually used if cardiopulmonary bypass (CPB) has to be employed. The preferred surgical incision for BLT is a bilateral transverse thoracotomy joint across the middle, best known as a clamshell incision. Cannulation for CPB is achieved using the ascending aorta and both the inferior vena cava (IVC) and superior vena cava (SVC) with tapes around for sealed occlusion. After intensive animal research and clinical experience gained from kidney and liver donation, the technique of lung donation after cardiac death (DCD) has been established successfully in recent years.

Donor to recipient matching is based primarily on ABO blood group compatibility. Median sternotomy is the standard approach for heart transplantation. Although the surgical technique of heart transplantation is simple, there are certain specific circumstances in which the operation can be technically demanding and require careful planning to get the best outcome. Ventricular assist devices (VADs) are more commonly used as a bridge to transplantation, and many patients wait for heart transplantation with a functioning VAD or are listed for urgent procedure due to VAD-related complications. Heart-lung transplantation and domino heart transplantation have largely been superseded by bilateral sequential lung transplantation. Heterotopic transplantation allows much more leniency on the donor and recipient mismatching. Careful consideration should be given to the adequacy of cardiac output in maintaining oxygen delivery to the tissues, bleeding, collections, pneumothorax, and position of the monitoring lines.