Lung transplantation has been the last of the solid organs to gain traction as a viable therapeutic option. Due to differing standards of care and the relatively low number of lung transplants performed, it has proven difficult to orchestrate prospective multicenter studies to determine best practice and explore novel therapies. Nonetheless, there have been incremental advances in lung transplantation, including liberalization of criteria for both suitable donor organs as well as acceptable recipients. This has resulted in increasing numbers of procedures being performed, and outcomes have improved despite an expanding cohort of sicker patients undergoing lung transplantation. This review will discuss current trends and future developments with a focus on the most pertinent of the pitfalls that may accompany lung transplantation.