Heart-lung transplantation for cystic fibrosis has become an established form of treatment over the last few years. This paper considers the assessment and preparation of patients, the surgical procedure, immunosuppression, post-operative care and the results of surgery. The best survival rates to 1 year are 70%-80% with possibly a less favourable survival for younger patients. Major problems include shortage of donor organs, post-operative management of patients with multisystem disease and obliterative bronchiolitis. The majority of patients, however, do well with a greatly improved quality of life and the medium-term results are encouraging.