We were recently asked to provide cardiovascular consultation for a 51-year-old man with acute on chronic hypoxic respiratory failure due to severe and progressive pulmonary fibrosis. His pulmonary fibrosis was attributed to toxic effects from 6 cycles of a bleomycin-containing chemotherapeutic regimen and mediastinal radiation therapy for stage IIB Hodgkin lymphoma 3 years earlier that was curative. He was transferred to our institution for consideration of a lung transplant.