Abstract
The shortage of organ donors remains the major limiting factor in lung transplant,
with the number of patients on the waiting list largely exceeding the number of available
organ donors. Another issue is the low utilization rate seen in some types of donors.
Therefore, novel strategies are continuously being explored to increase the donor
pool. Advanced age, smoking history, positive serologies, and size mismatch are common
criteria that decrease the rate of use when it comes to organ utilization. Questioning
these limitations is one of the purposes of this review. Challenging these limitations
by adapting novel donor management strategies could help to increase the rate of suitable
lungs for transplantation while still maintaining good outcomes. A second goal is
to present the latest advances in organ donation after controlled and uncontrolled
cardiac death, and also on how to improve these lungs on ex vivo platforms for assessment
and future specific therapies. Finally, pushing the limit of the donor envelope also
means reviewing some of the recent improvements made in lung preservation itself,
as well as upcoming experimental research fields. In summary, donor lung optimization
refers to a global care strategy to increase the total numbers of available allografts,
and preserve or improve organ quality without paying the price of early-, mid-, or
long-term negative outcomes after transplantation.
Keywords
lung transplant - organ shortage - donor lung
