Data describing the use of ventilation as a bridge to lung transplantation are scant. However, data from the International Registry suggest that patients who are ventilated at the time of transplantation are at increased risk. The decision to offer invasive ventilatory support to a lung transplant candidate with acute respiratory failure should be individualized and based on variables that include likelihood of expeditious transplantation, and the presence of a reversible superimposed process. A trial of NPPV is justified in patients who present in acute respiratory failure, but is more likely to be successful in patients with hypercapnia and chronic airway obstruction. Lung transplant candidates with chronic respiratory insufficiency secondary to obstructive airway disease are at increased risk of acute respiratory failure, and a trial of NPPV might be considered on an individual basis after maximization of conventional medical therapy. More research in this area is necessary to further define the roles of both invasive and noninvasive ventilation as bridge therapy to lung transplantation.