Lung transplantation is now an acceptable therapeutic option in patients with end-stage lung disease. In pediatric lung transplantation, living-donor lung transplantation remains important with the current shortage of suitable cadaveric donor lungs. Especially for infants and small children, technical innovation of living lung transplant with adult middle lobe or lung segment instead of lower lobe is important because the adult lower lobe is too large to fit in to the small recipient chest. Five-year survivals of pediatric lung transplants at Okayama University and the world average are 89% and 51%, respectively. However, when it comes to lung growing, a size- and age-matched brain-dead pediatric donor remains ideal.