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Bilateral lung transplantation (BLT) has evolved into a routine procedure and is the most frequently performed method. Traditionally single lung transplantation (SLT) has been the procedure of choice in patients with non-infective end-stage lung disease such as chronic obstructive pulmonary disorder (COPD) and idiopathic pulmonary fibrosis (IPF). Most common incisions for SLT are the posterolateral thoracotomy, anterolateral thoracotomy and median sternotomy, which are usually used if cardiopulmonary bypass (CPB) has to be employed. The preferred surgical incision for BLT is a bilateral transverse thoracotomy joint across the middle, best known as a clamshell incision. Cannulation for CPB is achieved using the ascending aorta and both the inferior vena cava (IVC) and superior vena cava (SVC) with tapes around for sealed occlusion. After intensive animal research and clinical experience gained from kidney and liver donation, the technique of lung donation after cardiac death (DCD) has been established successfully in recent years.