Lung preservation is crucial for successful transplantation, especially when using marginal donor lungs. Novel organ preservation methods have been developed to improve the quality of donor lungs. Additionally, machine perfusion has been developed and applied clinically for the evaluation of donor lungs. Ex vivo lung perfusion (EVLP) enables normothermic evaluation of donor lungs, assessing parameters like gas exchange and compliance while also allowing therapeutic interventions. Recent studies have explored the use of gene therapy and mesenchymal stem cells (MSCs) during EVLP to reduce ischemia-reperfusion injury and improve graft function. EVLP has proven effective in treating injuries like pneumonia or aspiration damage, offering a promising platform for lung repair. With continued advancements in EVLP, extended preservation and better repair strategies are expected to enhance lung transplantation outcomes.