Fuel cell vehicles are considered to be a viable solution to problems such as carbon emissions and fuel shortages for road transport. Proton Exchange Membrane (PEM) Fuel Cells are mainly used in this purpose because they can run at low temperatures and have a simple structure. Yet to make this technology commercially viable, there are still many hurdles to overcome. Apart from the high cost of fuel cell systems, high maintenance costs and short lifecycle are two main issues need to be addressed. The main purpose of this paper is to review the issues affecting the reliability and lifespan of fuel cells and present the state of the art in fuel cell condition monitoring and maintenance. The Structure of PEM fuel cell is introduced and examples of its application in a variety of applications are presented. The fault modes including membrane flooding/drying, fuel/gas starvation, physical defects of membrane, and catalyst poisoning are listed and assessed for their impact. Then the relationship between causes, faults, symptoms and long term implications of fault conditions are summarized. Finally the state of the art in PEM fuel cell condition monitoring and maintenance is reviewed and conclusions are drawn regarding suggested maintenance strategies and the optimal structure for an integrated, cost effective condition monitoring and maintenance management system.