The past few decades have witnessed the rise of COPD as an important cause of morbidity and mortality, not only in the developed world but also in the rest of the world. Indeed, COPD is predicted to be the third highest cause of death and is estimated to be fifth in overall morbidity in the world by the year 2020.1 Over the same time period, treatment for the disease has also improved, with great advances in the treatment of smoking addiction, oxygen therapy, pharmacotherapy and pulmonary rehabilitation. Despite or perhaps due to these advances, more patients reach more severe stages of the disease and continue to complain of dyspnea and exercise limitation that impairs even the activities of daily living. This has paved the way for the exploration of several surgical alternatives, of which the one that has found acceptance is lung transplantation (see Chapter 33). However, the difficulties associated with the selection, preparation and treatment of patients who are transplanted and, more important, the limited number of donors, has restricted this option to relatively few patients (compared to the number of candidates) and few centers worldwide.