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Heart–lung transplant remains the final option for patients with congenital heart disease (CHD) and irreversible pulmonary vascular obstructive disease (PVOD) when the patients are symptomatic despite optimal medical management. This panel discussion, held during cardiovascular disease convergence 2018, takes us through the journey of an 18-year-old patient suffering from a complex cyanotic CHD with irreversible PVOD and severe ventricular dysfunction. Pertinent management issues concerning pharmacotherapy and supportive care are discussed. Finally, workup and listing criteria for heart–lung transplant are discussed. The patient still awaits heart–lung transplant.