Despite the recent advances in systemic therapy, survival for patients with metastatic non–small cell lung cancer (NSCLC) without actionable genomic alterations in the tumor is limited. A small subset of patients with NSCLC have lung-only metastatic disease and often die of progressive lung failure. In this issue of JAMA, a study by Bharat and colleagues challenges an entrenched assumption that lung transplant has no role in the management of patients with advanced NSCLC with lung-only metastatic disease.