ABSTRACT
End-stage lung disease is the third leading cause of death in the United States and a major health care challenge. 1 Lung transplantation is the only definitive treatment of end-stage lung disease, and it has been increasingly successful as a therapy that improves the quality and quantity of life for selected patients. 2 Only a minority of patients can benefit from it, however, because of the lack of acceptable donor organs. The largest source of donor lungs is donation after neurologic determination of death. Unfortunately, the number of lungs suitable for transplantation is low, thus leading to a disappointing procurement rate. An average of only 1700 lung transplant procedures are performed in the United States each year. The lack of donor lungs has been the impetus to create new tools to evaluate and potentially treat extended criteria lungs with ex vivo lung perfusion (EVLP), as well as to search for alternative lung sources, including donors who die after withdrawal of care and victims of sudden death (non–heart-beating donors [NHBDs]), bioengineering of whole lungs, and creation of artificial (mechanical) lungs. These emerging ideas and breakthroughs will probably contribute to the future of lung transplantation.
