While extracorporeal support of patients awaiting pulmonary transplantation is now well-established, extracorporeal membrane oxygenation (ECMO) remains a nondurable technology deployed for short-term support or recovery in patients with progressive disease. Here, we describe an anecdotal experience with pulmonary transplant after more than 1 year of continuous veno-venous ECMO support. The case highlights several issues relevant to the increasing use of bridging technologies: (1) the potential impact of extracorporeal circulation on immune sensitization, (2) the safety and questionable need for anticoagulation in long-term ambulatory veno-venous extracorporeal support, and (3) the increasing durability of contemporary ECMO support technologies.