text: Lung Transplantation of COVID 19 Patients How I Do It The COVID 19 pandemic has caused acute lung injury in millions of individuals worldwide Some patients develop COVID related acute respiratory distress syndrome CARDS and cannot be liberated from mechanical ventilation Others may develop post COVID fibrosis resulting in substantial disability and need for long term supplemental oxygen In both of these situations treatment teams often inquire about the possibility of lung transplantation In fact lung transplantation has been successfully employed for both CARDS and post COVID fibrosis in a limited number of patients worldwide Lung transplantation after COVID infection presents a number of unique challenges that transplant programs must consider In those with severe CARDS the inability to conduct proper psychosocial evaluation and pretransplantation education marked deconditioning from critical illness and infectious concerns regarding viral reactivation are major hurdles In those with post COVID fibrosis our limited knowledge about the natural history of recovery after COVID 19 infection is problematic Increased knowledge of the likelihood and degree of recovery after COVID 19 acute lung injury is essential for appropriate decision making with regard to transplantation Transplant physicians must weigh the risks and benefits of lung transplantation differently in a post COVID fibrosis patient who is likely to remain stable or gradually improve in comparison with a patient with a known progressive fibrosing interstitial lung disease fILD Clearly lung transplantation can be a life saving therapeutic option for some patients with severe lung injury from COVID 19 infection In this review we discuss how lung transplant providers from a number of experienced centers approach lung transplantation for CARDS or post COVID fibrosis 