Lung transplantation with or without cardiac transplantation offers the only hope of long-term, symptom-free survival for patients with advanced idiopathic pulmonary arterial hypertension. We describe a patient who underwent an emergency pulmonary embolectomy. During surgery, it was discovered that the patient had idiopathic pulmonary arterial hypertension. After the patient was weaned from cardiopulmonary bypass, pulmonary hypertension caused right-sided heart failure, and a right ventricular assist device was inserted to compensate. Because of profound bleeding from the endotracheal tube, the patient was placed on extracorporeal membrane oxygenation in the hope of bridging the patient to heart-lung transplantation. Extracorporeal membrane oxygenation was required for 10 days until a donor heart and lung became available. The patient recovered from the transplant operation and was discharged home 76 days later.