Purpose Patients awaiting lung transplantation experience physical symptoms and psychosocial issues that impact their health and quality of life. Palliative care (PC) is focused on symptom control and psychosocial support, but PC is often not consulted in the management of lung transplant candidates. Recently, referral of listed patients to PC has increased at our center. We studied the timing of PC referral, the care provided by the PC team and patient outcomes. Methods and Materials Single center retrospective cohort study of lung transplant candidates referred for PC consultation from Jan 2010—May 2012. We collected patient demographics, wait list status, location at time of consultation, PC interventions and patient outcomes. For patients initiated on opioids, we compared treadmill exercise intensity during physiotherapy pre- and post-opioids. Results 64 patients (29 male) were included. 53% were on the rapidly deteriorating list. Mean age was 59.4±9.4 years. Diagnoses were ILD (51), COPD (4), PAH (4), CF (0) and bronchiolitis obliterans (5). Consult locations were ICU (1), ward (28) and clinic (34). PC referral occurred a median of 65 (range, -207 to 718) days from listing and 32 (range, 0 to 461) days prior to transplant, delisting or death. Reasons for referral were dyspnea (90%), cough (28%), pain (19%), anxiety (19%) end of life planning (6%) and depression (5%). Most patients (92%) were prescribed opioids following PC consultation. Mean exercise intensity was 1.9±0.2 METS pre-opioids and 2.0±0.2 METS post-opioids (p=0.3). At time of review 47% patients were transplanted, 36% had died on the list, 14% were delisted and 3% were still wait-listed. Of the 27 patients whose deaths occurred at our centre, 23 were receiving comfort medications and only 1 received CPR. Conclusions In patients awaiting lung transplantation, PC need not be delayed until the final hours but can be provided earlier without compromising eligibility for transplant or exercise tolerance. The effect of PC interventions on patient quality of life requires further study.