This retrospective single-center study evaluates the outcomes of isolated single lung transplants (SLT) (one usable, one declined lung) compared to split SLTs (both lungs are used for different recipients). Approximately 80 percent of lung transplants are bilateral, leading to a paucity of literature on isolated SLT outcomes. A total of 164 patients underwent split SLT, and 271 received an isolated SLT. Survival rates did not differ significantly between isolated and split SLT recipients (HR 0.97, CI 0.72–1.33, p = 0.87), with no significant differences found in the need for ECMO, postoperative ventilation, or length of hospitalization. These findings suggest that isolated SLT is a safe and viable option, offering survival outcomes comparable to those of split SLT. This could indicate that well-selected isolated donor lungs can be used safely, expanding the limited donor pool and reducing waitlist mortality.