Patients who suffer advanced lung disease associated to respiratory infection and who are candidates for transplantation must have both lungs replaced. Until recently, this procedure was accomplished by transplanting a heart-lung block, a procedure of questionable merit if the heart is healthy, or by carrying out a double-lung transplant requiring extracorporeal circulation and involving a high percentage of complications the tracheal anastomosis. The year 1990 saw publication of the first descriptions of a simpler procedure, sequential double-lung transplantation. After brief experience with good results in single-lung transplantation, we present the first three cases of sequential double-lung replacement carried out in Spain. We describe the consecutive substitution of both lungs, with no need for extracorporeal circulation in most cases. Sequential bilateral lung transplantation combines the advantages of single-lung transplantation with the use of anterior thoracoesternotomy to provide good access to both pleural cavities, facilitating the procedure when pleural adhesion is present.