Introduction

Three critical factors led to the birth of heart–lung transplantation (HLT) in 1981; the visionary approach of Norman Shumway [1], the application of Bruce Reitz [2] and the availability of the novel immunosuppressive agent ciclosporin [2, 3]. The new discipline had a difficult birth and a tumultuous childhood. The world's first heart–lung transplant recipient spent four months in hospital due in part to bilateral phrenic nerve paresis. Despite restrictive physiology [4] and early concerns regarding the relevance of the Hering–Breuer reflex in mammalian species [5] the outcome was eminently successful, at least for five years. Her ultimate demise from complications of acute renal failure occurred after a fall at home in which she transected her short gastric artery. At postmortem the transplanted organs were pristine. This abbreviated case history of the first HLT recipient emphasizes the multiorgan complexity of lung transplantation and the potential risks associated with a simple fall in the immunosuppressed host.

The ensuing 21 years have been just as exciting for those privileged to be involved in this new dimension of care of patients for whom no other therapy offered the chance of ongoing survival and quality of life. The science of lung transplantation has evolved from an experimental procedure, through an investigative procedure, to be accepted as a legitimate mainstream therapy for patients with life-threatening pulmonary diseases. Similarly, living lobar pulmonary transplantation was first performed in 1993 and has now achieved a position as accepted therapy, with survival rates equivalent to lung transplantation using a cadaveric donor [6].