OBJECTIVES: Lung transplant is increasingly becoming the choice of therapy for several end-stage pulmonary conditions. Factors critical to making decisions for a lung transplant revolve around transplant costs and improvements in health-related quality of life (HRQL) post-transplant. The primary objectives of this study are: a) To compare the HRQL of transplant recipients versus candidates; and b) To compare recipients versus candidates on utilities derived using two methodologies by Nichol et al (2001) and Brazier et al (2002). METHODS: A survey questionnaire was mailed to 145 lung or heart-lung transplant recipients and 99 candidates awaiting lung transplant at a major University hospital in the Midwestern USA. The questionnaire comprised of instruments such as the SF-36, Center for Epidemiologic Studies Depression (CES-D) Scale, Symptom Distress Scale (SDS), Illness Intrusion Rating Scale (IIRS), Pulmonary Scale (PS), Dyspnea Scale (DS), and Health Status (VAS). T-tests were employed to analyze differences between the two groups on the HRQL measures. RESULTS: There were a total of 166 respondents (99 recipients and 67 candidates). Recipients had significantly higher SF-36 PCS scores (39.97 vs. 25.56, p=0.001) and VAS scores (73.30 vs. 49.24, p=0.001) as compared to the candidates. No significant differences were observed between the 2 groups on the SF-36 MCS and CES-D scores. Recipients demonstrated significantly lower levels of dyspnea, pulmonary distress, and illness intrusion in comparison to transplant candidates. Both the methodologies for deriving utilities from the SF-36 yielded higher scores for recipients versus the candidates; Nichol utilities (0.76 vs. 0.69, p=0.001) and Brazier utilities (0.70 vs. 0.63, p=0.001). CONCLUSIONS: It was observed that in general recipients had significant improvements in physical health as compared to candidates. The incremental benefit in terms of utilities would be larger when calculated using the Nichol methodology, despite both methodologies being based on the SF-36 and standard gamble. Further research needs focus on the validity of these utilities for purposes of a cost-utility analysis.