Introduction: Combined heart and lung transplant is a rare procedure performed for patients with congenital heart disease and end stage pulmonary disease. Due to improvement in survival, non-cardiac surgeries are frequently performed in these patients and anaesthetists are involved in their perioperative management. Apart from increasing the physical and mental health risks, COVID-19 pandemic has posed an additional challenge to health care providers in the management of these immunosuppressed patients. Case presentation: We report a case of a 64-year-old female patient with a previous combined heart and lung transplant who underwent two consecutive lower limb surgeries during COVID pandemic. Conclusion: Meticulous preoperative assessment involving multidisciplinary team, knowledge of the pathophysiology of heart-lung transplant patients, choosing appropriate anaesthetic technique is vital in successful management of these patients. Psychological implications of COVID-19 pandemic in immunosuppressed patients should be considered.