During the past decade we have witnessed a continuing evolution in intrathoracic transplantation. The role of heart transplantation in end-stage heart disease has been well established; and combined heart-lung and lung transplantation techniques developed during the past 10 years have been applied to an expanding array of diseases associated with end-stage pulmonary failure. Recently a plateau in number of transplants per year has become evident. Although the areas of pediatric heart and single lung transplantation continue to expand, it appears that further overall growth in heart and lung transplantation is now limited by donor availability. Although operative mortality has shown gradual improvement, organ preservation and other intraoperative complications remain major factors associated with early death, especially in combined heart-lung and lung transplantation. Infection and rejection are the most common causes of late deaths for all types of intrathoracic transplantation. Although long-term survival has shown improvement over the past 10 years, an increasing number of patients now require retransplantation because of chronic rejection. Results with heart, combined heart-lung, and lung retransplantation, in operative mortality and in long-term survival, have not been as encouraging as with the primary transplant procedure. We await further developments in heart and lung transplantation during the new decade.