One of the inevitable consequences of success in a new clinical procedure would appear to be a slow but steady relaxation of strict guidelines pertaining to patient selection as familiarity increases. Nowhere has this been more evident than in the field of lung transplantation. After two decades of failure, the early 1980s were characterised by the cautious introduction of heart and lung transplantation for pulmonary vascular disease and single lung transplantation for fibrosing lung disease with clinical success.¹

Transplant surgeons and, indeed, their physician colleagues were, however, blessed with a pioneering spirit and were keen to take on new challenges. This manifest itself by the development of a flood of ever increasing indications for lung transplantation. In this respect the decision to perform heart lung transplantation in a patient with respiratory failure due to cystic fibrosis was a milestone. The idea of transplanting an essentially septic recipient with a systemic . . . [Full text of this article]