Thoracic organ transplantation has evolved as standard therapy in end-stage cardiac and pulmonary failure. Meanwhile more than 50.000 heart, 2500 heart-lung and 10.000 lung transplantations have been performed worldwide. Improvements in patient selection as well as in the postoperative management have led to 1-year survival rates of 70-90%. Long-term results are still influenced by the development of graft vessels disease, bronchiolitis obliterans syndrome and malignancies. Furthermore, indications and results of different procecures will be presented and new developments discussed.