Hemodynamic management in lung transplantation centers on maintaining adequate perfusion while avoiding elevations in pulmonary artery pressure. Specific hemodynamic goals depend on whether the surgery is performed on or off ECMO. Off ECMO aims for MAP 60–70 mmHg, raising to 80–90 mmHg in patients with vascular disease. Pulmonary artery (PA) test clamping identifies high PA pressures and RV vulnerability. Intraoperative ECMO is preemptively initiated in cases of severe PH, RV dysfunction, or challenging anatomy. On ECMO targets MAP 60–80 mmHg, with flows adjusted for oxygenation, perfusion, and CO2 clearance. Loss of PA pulsatility suggests hypovolemia or excessive ECMO flow.