The number of lung and heart-lung transplantations is growing rapidly, and hundreds of combined heart-lung, single-lung, and double-lung transplantations have been performed to date, resulting in increased survival and improved quality of life for patients with end-stage pulmonary disorders. Improved surgical technique, immunosuppression, and optimal patient selection are largely responsible for this success. Although the indications for transplantation continue to expand, the number of potential recipients far exceeds the number of available donors, making the evaluation and selection process vital to the success of any transplantation program. A multidisciplinary approach is presented that can be expected to eliminate a large number of prospective candidates and thus enhance matching limited donor organs with transplantation candidates.