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Heart transplantation is a treatment option for selected patients with end-stage heart failure. Lung transplantation is an alternative surgical therapy for patients with end-stage lung disease. The major challenges in this and the next decade are to: make available more organs for transplantation through maximization of the donor pool; design more effective and less toxic immunosuppressive regimens; and extend long-term survival by preventing cardiac vasculopathy and obliterative bronchiolitis.