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More than 6400 lung transplants have been performed since the first successful operations in the early 1980s.(1) Lung transplant programs now exist in many countries. Internationally, the number of donor organs available is far fewer than the number of patients with end-stage lung disease. Because of this many candidates die on the waiting list and the average wait to receive a donor organ may approach two years.(2) Overall survivals are between 60 and 65 per cent at two years and approximately 40 per cent at five years.(1) Considering the resource limitations and the importance of assuring optimum outcomes, we believe that international guidelines for selection of appropriate candidates for lung transplant will ensure a fair distribution of donor organs. Transplant physicians and surgeons representing the International Society of Heart and Lung Transplantation, the American Society of Transplant Physicians …