Laryngeal and tracheal transplantation have been proposed as treatments for irreversible airway disease for many years. Despite much research, there has only been one true laryngeal transplant reported. Although this was in many ways a success, several barriers remain before full clinical trials. There are issues over patient selection, reinnervation, immunosuppression, and cost-benefit. For the trachea, where finely tuned neuromuscular activity is not an issue, tissue-engineering probably represents the future. This overview discusses the arguments for and against laryngeal and tracheal transplantation and suggests ways of overcoming these barriers.