A heart–lung transplant is a procedure carried out to replace both heart and lungs in a single operation. Due to a shortage of suitable donors and due to the fact that both heart and lung have to be transplanted together, it is a rare procedure; only about a hundred such transplants are performed each year in the United States. Qualifying conditions Most candidates for heart–lung transplants have life-threatening damage to both their heart and lungs. In the US, most prospective candidates have between twelve and twenty-four months to live. At any one time, there are about 250 people registered for heart–lung transplantation at the United Network for Organ Sharing (UNOS) in the US, of which around forty will die before a suitable donor is found. Conditions which may necessitate a heart–lung transplant include: Congenital problems (defects present at birth) affecting the heart and lungs (48%); Pulmonary hypertension (20%); Cystic fibrosis (2%); A second transplant after the first transplant was rejected or failed to operate satisfactorily (4%). Candidates for a heart–lung transplant are usually required to be: Under 55 years old; Have no other medical conditions (e.g. AIDS, Diabetes, Hepatitis); Mentally sound; Capable of following a post-operative regimen of exercise and immunosuppressant drugs. History Norman Shumway laid the groundwork for heart lung transplant with his experiments into heart transplant at Stanford in the mid-1960s. Shumway conducted the first adult heart transplant in the US in 1968. While the first successful heart transplant was performed in South Africa in 1967 , the first successful heart–lung transplant was performed at Stanford in the United States, by Bruce Reitz on Mary Gohlke in 1981 . Magdi Yacoub performed the first heart-lung transplant in the United Kingdom in 1983. Australia's first heart-lung transplant was conducted by Victor Chang at St Vincent's Hospital, Sydney in 1986. Iran's first heart-lung transplant was performed in Tehran in 2002. Procedure The patient is anesthetised. When the donor organs arrive, they are checked for fitness; if any organs show signs of damage, they are discarded and the operation cancelled. Once suitable donor organs are present, the surgeon makes an incision starting above and finishing below the sternum, cutting all the way to the bone. The skin edges are retracted to expose the sternum. Using a bone saw, the sternum is cut down the middle. Rib spreaders are inserted in the cut, and spread the ribs to give access to the