Lung transplantation is a recognised therapy for end stage respiratory failure in children and young people. It is only available in selected countries, and is limited by access to suitable organs. Data on disparities in access and outcomes for children undergoing lung transplantation are limited. It is clear that data from studies in adults, and from studies in other solid organ transplants in children, that systemic iniquities exist in this field. While data relating specifically to paediatric lung transplantation are relatively sparse, professionals should be aware of the risk that health care systems may result in disparities in access and outcomes following lung transplantation in children.