Novel Strategies for Optimization of the Pre-transplant Donor Lung

While the number of lung transplants continues to increase, there remains an imbalance between potential lung transplant candidates and acceptable donor lungs resulting in excess mortality. We sought to describe the current state of donor acceptance practices and highlight novel approaches that have the potential to result in an increase in acceptable lungs available for transplant.

Increased utilization of lungs from donors with positive nucleic acid amplification tests for hepatitis C, donation after circulatory death, lungs conditioned for transplant at Centralized Lung Evaluation facilities using ex vivo lung perfusion, and improvements in organ storage during transport, have the potential to immediately increase the number of lungs suitable for transplant. In the future, application of advanced therapeutics using the ex vivo lung perfusion, stem-cell and gene therapy, and cross-circulation organ support may allow for transplant of previously non-transplantable organs.

Scientific advances in the management of donor organs may conceivably lead to a future where lungs are tailored to the unique needs of the potential recipient, resulting in an increase in lung transplants performed and improvements in long-term survival sorely desired by clinicians, researchers, and patients alike.