Second Chance Lungs: Can Ventilated Donors Expand Lung Transplant Options?
"Research explores the viability of using lungs from donors mechanically ventilated for extended periods, potentially increasing the donor pool."
The demand for lung transplants far exceeds the supply of available organs, leading to prolonged waiting times and, unfortunately, many deaths. This scarcity has prompted researchers to explore unconventional avenues for expanding the donor pool, including the use of lungs from donors who might have previously been deemed unsuitable.
One such area of investigation focuses on lungs from donors who required mechanical ventilation for an extended period. Typically, lungs from donors ventilated for more than 5 days are considered marginal and often declined due to concerns about potential damage and reduced function. However, with careful evaluation and management, these lungs might still offer a viable option for patients in desperate need.
This article examines recent research into the feasibility of using lungs from donors mechanically ventilated for prolonged periods, assessing the outcomes of lung transplants performed with these organs and exploring the potential benefits and risks involved. By understanding the findings, we can gain insights into whether this approach could help alleviate the organ shortage and improve outcomes for lung transplant candidates.
Established Treatment, Persistent Constraints
Lung transplantation has evolved from an experimental procedure into a standard treatment, according to the New England Journal of Medicine review. It remains the definitive treatment for end-stage lung disease, but the field continues to face a limited supply of donor organs. Current challenges also include ongoing debate over optimal preservation methods and the best intraoperative support systems. Recent reviews describe lung transplantation as carrying the highest mortality risk among solid-organ transplants, reflecting complex interactions between donor organs and recipient physiology.
Prolonged Ventilation: Does It Compromise Lung Transplant Success?
A study published in The Journal of Heart and Lung Transplantation investigated the outcomes of lung transplants using lungs from donors ventilated for both short (<5 days) and long (≥5 days) durations. The researchers retrospectively analyzed data from 81 patients who underwent lung transplantation at their institution between January 2001 and May 2017.
- Despite the longer ventilation period, the study found that the lung donor score and other donor characteristics were similar between the two groups.
- There was no significant difference in the incidence of primary graft dysfunction, acute rejection, pneumonia, or bronchial complications between the groups.
- Chronic lung allograft dysfunction-free survival was similar in both groups, and the overall survival rate after lung transplantation was comparable between the LT and ST groups (5-year survival rate: 66.6% vs. 75.2%).
Research Focuses on Precision and Preservation
Recent research includes techniques for controlling intraoperative bleeding during lung transplantation for pulmonary hypertension. In one study, the median number of hemoclips was significantly higher in the primary pulmonary hypertension group than in both the non-pulmonary-hypertension group and the secondary pulmonary-hypertension group. Reviews also highlight emerging biomarkers intended to clarify immune-mediated mechanisms of acute and chronic rejection and support precision medicine. A 2025 clinical research review identifies donor-lung screening tools, optimized lung perfusion, extracorporeal membrane oxygenation, and robot-assisted minimally invasive surgery as active areas of investigation.
Comparing Risk and Early Recovery
A study of pulmonary hypertension before first and second lung transplantation examined consecutive adult patients aged 16 years or older who underwent lung retransplantation between 1997 and 2009. The study used right-heart catheterization data collected before both the first and second transplantations. Separately, research using ex vivo lung CT found that recipients in the bilateral-lung-transplantation infiltration group recovered more slowly from primary graft dysfunction and had longer periods of mechanical ventilation and intensive-care-unit stay than recipients in the bilateral-lung-transplantation control group.
Expanding the Horizon of Lung Transplantation
The research highlights the potential for safely utilizing lungs from donors who required prolonged mechanical ventilation, a practice that could significantly increase the number of available organs for transplantation. This is particularly crucial given the persistent shortage of donor lungs and the growing number of patients awaiting transplantation.
Expanding Supply Requires Standardization
The 2024 American Association for Thoracic Surgery expert guidance describes donor-lung procurement and preservation as critical to transplant success. It also reports substantial variability in techniques, with consequences for organ-utilization rates and transplantation outcomes. New developments in cold static preservation and machine perfusion have added complexity to the procedure. Strategies for addressing shortages therefore combine logistics-extending preservation, broader donor pathways, advanced graft assessment, and carefully expanded donor-acceptance criteria, while standardized prospective multicenter trials remain a stated need.
Access and Long-Term Outcomes
Lung transplantation remains the only definitive treatment for end-stage lung disease, according to a 2025 narrative review. The review describes progress throughout 2025 in addressing persistent challenges across the field, including issues at the policy level. Future priorities identified by CHEST Physician include improving donor-organ utilization, promoting equitable access, and reducing the impact of chronic lung allograft dysfunction. Together, these priorities show that progress involves both expanding transplantation opportunities and improving long-term outcomes.
From Referral to Real-World Evidence
A 2026 case study reports that organ-donation rates have increased nationally while transplantation rates have remained flat. The national transplant community is responding through growth-collaborative projects focused on increasing organ utilization, including efforts to address prolonged time from lung-transplant referral to waitlisting. The Organ Donation and Transplantation Alliance describes case studies as resources for showing how policies, practices, and innovations work in real-world settings. Separately, the International Society for Heart and Lung Transplantation registry report calls its 2019-2024 analysis of donation after circulatory death lung transplantation the largest international study to date of DCD-donor utilization and post-transplant outcomes.
While the study provides encouraging results, it's important to acknowledge that careful donor selection and meticulous evaluation of lung function are essential to ensure successful transplant outcomes. Further research is needed to identify specific criteria for identifying suitable candidates among donors ventilated for extended periods.
By refining donor selection strategies and optimizing post-transplant management, the use of lungs from donors mechanically ventilated for prolonged periods could become a valuable tool in addressing the organ shortage and improving the lives of patients with end-stage lung disease.