Ex vivo lung perfusion (EVLP) allows for the evaluation and rehabilitation of donor lungs prior to transplantation. EVLP employs acellular perfusate, lung-protective ventilation, and controlled normothermia to assess an optimized graft function outside the body. EVLP can be performed using different techniques, including the Lund protocol, the Toronto protocol, and the Organ Care System (OCS) protocol. The Toronto protocol emphasizes gradual rewarming and perfusion, with real-time physiological assessment determining suitability for transplant. EVLP typically runs for 3–4 h, allowing safe extension of preservation time. Long-term studies show no difference in survival, graft function, or quality of life between EVLP and non-EVLP recipients, thereby safely expanding the donor pool without compromising outcomes.