This paper focuses on product portfolio management in a large multinational medical device organization. The contribution of this research is to provide insights into the nature, composition and decision making processes of product portfolios in a real world setting. The research is important because portfolio management decisions have a significant impact and influence the performance at each stage in the product life cycle. Results of the study indicate that portfolio management is a complex process in general but particularly challenging when dealing with technology development projects or innovative new products as unchartered waters are difficult to assess. We found that there are challenges with transparency and that stakeholders need fact based and information driven decisions. There is a need for better up front planning and systems to guide the process. Consistent criteria should be used to select and prioritize projects to facilitate better comparative ranking and allow for balanced portfolios, as well better resource distribution. However we also found that these criteria may change depending on the stage in the lifecycle.