This chapter begins with a review of the indications for heart transplantation, then presents recipient evaluation and pretransplant management. Then, donor management, surgical technique, and anesthetic management are discussed. Immunosuppression and rejection therapy are then summarized. Next, heterotopic heart transplantation, combined heart and liver transplantation, and retransplantation are ... [Show full abstract] discussed, followed by a discussion of anesthetic management of children who have undergone heart transplant. The last part of the chapter focuses on lung transplantation, including indications, contraindications, and listing criteria; and then donor management, anesthetic management and surgical approach. A discussion of primary graft failure, surveillance procedures, surgical and medical complications including rejection and bronchiolitis obliterans follows. Finally, mortality and long-term survival after lung transplant in children are presented.