Volume assessment during lung transplantation is challenging due to altered physiology, surgical manipulation, and concurrent ECMO. Central venous pressure is unreliable, and dynamic measures such as pulse pressure variation are frequently confounded. Volume status must be inferred from a constellation of findings, including urine output, TEE assessment, lactate trends, and response to fluid boluses. Accurate assessment is essential to guide resuscitation, as both hypovolemia and fluid overload can lead to adverse outcomes, including primary graft dysfunction, organ hypoperfusion, and failure of extracorporeal support.