Of 27 children referred for assessment of suitability for heart-lung transplant, 10 (37%) were actually transplanted. Six are still alive from three months to three years since operation. Two thirds of the cohort have died at various stages during referral, assessment, and transplant. While the transplant has offered miraculous new life to a few children, many more have experienced increased and unnecessary suffering. Planning of transplant programmes must take all facts into account. The possibility of heart-lung transplant must not deter further efforts to control chronic lung diseases medically and must not influence appropriate terminal care.