Thoracic organ transplantation in childhood and adolescence may be a strategic goal of therapy in the treatment of chronic diseases. After heart transplantation the survival rates are more favorable than those of lung transplantation. Combined heart and lung transplantation is only reserved for special indications of lung disease in combination with end-stage right heart failure. All modern conservative and invasive treatment options for the underlying disease must be used before a listing. Due to the limited availability of donor organs the possible waiting time has to be included into the therapeutic strategy for the patients. After a successful transplantation a significant improvement in quality of life is usually achieved. Most children return to a normal rhythm of life with little or no limitation of their physical and mental capabilities. Normally, a full physical rehabilitation is possible. A thorough patient checkup for the indication and an adequate selection of donors and recipients is the cornerstone for a successful transplantation. Lifelong immunosuppression is required with possible side effects.