The first successful living-donor lobar lung transplant (LDLLT) in Japan was performed at Okayama University in October, 1998 after a long period of waiting for the legalization of the thoracic organ transplantation. By May, 2005, a further 67 lung transplants have been performed; 45 from living donors and 22 from cadaveric donors. Although the number of lung transplants is still small, survival in Japan, at 76.9% after 5 years, is better than the world average. Because the number of available cadaveric donors for lung transplantation is limited at less than 5 per year, LDLLT is a realistic option for properly selected candidates.