Experimental lung transplantation began in the former Soviet Union in 1946. Experiments in the 1950s sought to understand the physiology and to master the technique of reimplantation. Study of the immunology of allografting in the 1960s lead to the first lung transplantation in a human in 1963 in the United States. Palliative lung transplantation was first reported from Canada in 1986 after the advent of effective and tolerable immunosuppressive regimens. Lung transplantation in centers of excellence is now an effective palliative method for more than 80% of carefully selected recipients. Widespread transplantation to treat end stage pulmonary dysfunction is impossible because of too few organ donors and imperfect management of rejection and infection.