title: Strategies for safe donor expansion: donor management, donations after cardiac death, ex-vivo lung perfusion.
abstract: OBJECTIVE
  The number of patients listed for lung transplantation largely exceeds the number of available transplantable organs because of both a shortage of organ donors and a low utilization rate of lungs from those donors. Two major innovations in recent years include the use of lungs from donations after cardiac death (DCD) and the use of ex-vivo lung perfusion (EVLP) to assess and improve injured donor lungs.
  
  
  RESULTS
  DCD lung transplants now account for about 20% of lung transplants in many centres and outcomes after transplantation have been excellent with this source of donation. Clinical experience using EVLP has shown the method to be well tolerated and allow for reassessment and improvement in function from high-risk donor lungs. When these lungs were transplanted, low rates of primary graft dysfunction were achieved and long-term survival was comparable with standard transplantation. Preclinical studies have shown a great potential of EVLP as a platform for the delivery of novel therapies to repair injured donor lungs.
  
  
  CONCLUSIONS
  A significant increase on the number of available lungs for transplantation is expected in the coming years with the wider use of DCD lungs and with organ-specific ex-vivo treatment strategies.
authors.affiliation: aDivision of Thoracic Surgery, Toronto Lung Transplant Program, University of Toronto bToronto Lung Transplant Program, Latner Thoracic Research Laboratories, FG Pearson - RJ Ginsberg Chair in Thoracic Surgery, Division of Thoracic Surgery and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Cypel
authors.forename: Shaf
authors.initials: S
authors.lastname: Keshavjee
mesh_terms: D000818:Animals; D003643:Death; D006801:Humans; D008168:Lung / Q000503:physiopathology* / Q000601:surgery; D016040:Lung Transplantation / Q000009:adverse effects; D010477:Perfusion / Q000379:methods*; D055031:Primary Graft Dysfunction; D014019:Tissue Donors / Q000600:supply & distribution