The advantage of single-lung transplantation is obvious. With the limited donor lung supply, the prospect of offering single-lung transplants to two recipients, as opposed to one bilateral lung recipient, is appealing. However, before this question can be fully answered, we also need to consider the limitations of the work by Gerbase et al.12 First, the study was relatively small and included relatively few single-lung transplant recipients (n = 14). Second, there is a trend toward improved SGRQ scores in bilateral lung transplant recipients compared to single-lung transplant recipients at later time points (mean score at 5 years, 87 vs 71, respectively). The negative statistical results of the study could be a type II error related to underpowering (details regarding a formal power calculation were not provided). Third, the study only considers HRQOL but not quality-adjusted life years (QALYs). International registry data would suggest that long-term survival is superior among bilateral transplant recipients compared to single-lung transplant recipients. The results of the study by Gerbase et al12 would be consistent with this observation in that 3 of 14 single-lung transplant recipients (21%) died during follow-up, while only 10% of bilateral transplant recipients died (3 of 30 patients). A formal QALYs evaluation in bilateral lung transplant recipients is not possible in the study by Gerbase et al12 because 18 transplant recipients who died within the first 2 years were excluded from analysis. Based on the data available in the article, bilateral transplantation appears to be superior in terms of QALYs. Furthermore, if there were a significantly greater number of single-lung transplant recipients among those early deaths, then bilateral lung transplantation would offer a striking advantage in evaluations of QALYs.