Significant improvements in human lung transplantation have occurred since the first successful single lung transplant in 1983 and the first bilateral transplant in 1986. Despite improvements with donor selection, challenges remain in lung preservation, recipient prioritization, perioperative mortality, and long-term morbidity. In an effort to optimize the benefits derived from lung transplantation, the United Network for Organ Sharing (UNOS) recently reorganized the prioritization scheme by which potential recipients were listed. The focus of this article is to review the current status of lung transplantation for emphysema, with attention given to current outcomes and management strategies.