Lung transplantation is an established therapy for end-stage lung disease. However, donor shortage remains as a serious issue in Japan. Appropriate brain-dead donor management is the first step toward safe lung transplantation, and the perioperative management begins at the donor hospital. This article overviews the key points of perioperative management in lung transplantation, starting from the donor,the graft, followed by the recipient. Lung transplantation is not just about implanting lungs;it is also about "conditioning" the lungs to be fully functioned after transplantation. In addition to respiratory management, circulatory management, immunosuppressive therapy, and antimicrobial chemotherapy, physiotherapy and nutritional therapy to support them are all indispensable. In other words, it is a treatment including all aspects of surgical managements, which is why it is fascinating.