Heparin-induced thrombocytopenia (HIT) in patients on mechanical circulatory support (MCS) prior to lung transplantation poses a unique challenge of balancing thrombotic versus hemorrhagic complications. An alternative method of anticoagulation is bivalirudin, offering advantages of rapid titration and a short half-life. We present 2 cases of patients on MCS who developed HIT and were anticoagulated with bivalirudin preoperatively. Contingent on whether additional cannulation was required at the time of lung transplantation, bivalirudin was held either at incision or after cannulation. Both patients were successfully transplanted without coagulopathic complications.