In the past 3 years we and other centers have accumulated a small experience with double lung transplantation. We continue to believe that it offers potential benefit to patients with bilateral septic lung disease and possibly to those with obstructive lung disease as well. We have encountered significant airway complications that several other centers have avoided by improved preservation and the technical modification of bilateral bronchial anastomosis. Reliable resolution of the problem of airway viability will permit more widespread application of double lung transplantation in selected patients with end-stage pulmonary disease.