Revisiting extended-criteria donors in lung transplantation
4 affiliations
- 1Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
- 2Prague Lung Transplant Program, 3rd Department of Surgery, First Faculty of Medicine, Charles University, Motol and Homolka University Hospital, Prague, Czech Republic
- 3Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
- 4Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium; Department of Pulmonology, University Hospitals Leuven, Leuven, Belgium
Abstract
Lung transplantation (LTx) is an established life-saving therapy for patients with end-stage lung disease. Despite continuous improvements in surgical technique, immunosuppressive regimen and perioperative care, organ shortage remains the principal limitation to broader access. Historically, conservative donor criteria have contributed to the underutilization of potentially transplantable lungs. Over time, lungs from donors outside standard criteria – commonly referred to as extended-criteria donors (ECD) – have been increasingly accepted. This narrative review evaluates contemporary evidence on the experience and outcomes of specific ECD lungs in LTx. We focus first on typically defined ECD including older donor age, smoking history and substance abuse, oxygenation status, radiological abnormalities, microbial colonization, donation after circulatory death, and extended ischemic times. Subsequently, we look at specific donor traits tempering them as emerging ECD. Finally, we evaluate the role and potential benefits of novel preservation and assessment techniques such as controlled hypothermic storage and ex vivo lung perfusion. While accumulating data support the safe use of ECD lungs under appropriate conditions, a paradigm shift toward individualized donor assessment rather than rigid thresholds is mandatory to sustainably expand the donor pool and reduce waitlist mortality.
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BibTeX
@article{vanluyten2026revisiting,
title = {{Revisiting extended-criteria donors in lung transplantation}},
author = {Cedric Vanluyten and René Novysedlak and Annalisa Barbarossa and An-Lies Provoost and Jan Van Slambrouck and Lori van Roozendaal and Maxime Van den Brande and Andrea Zajacova and Bart M. Vanaudenaerde and Robin Vos and Robert Lischke and Dirk E. Van Raemdonck and Laurens J. Ceulemans, (MD, PhD)},
journal = {JHLT Open},
year = {2026},
month = sep,
doi = {10.1016/j.jhlto.2026.100689},
url = {https://doi.org/10.1016/j.jhlto.2026.100689},
note = {CC BY},
}
RIS
TY - JOUR
TI - Revisiting extended-criteria donors in lung transplantation
AU - Cedric Vanluyten
AU - René Novysedlak
AU - Annalisa Barbarossa
AU - An-Lies Provoost
AU - Jan Van Slambrouck
AU - Lori van Roozendaal
AU - Maxime Van den Brande
AU - Andrea Zajacova
AU - Bart M. Vanaudenaerde
AU - Robin Vos
AU - Robert Lischke
AU - Dirk E. Van Raemdonck
AU - Laurens J. Ceulemans, (MD, PhD)
PY - 2026
DA - 2026/09/18
JO - JHLT Open
DO - 10.1016/j.jhlto.2026.100689
UR - https://doi.org/10.1016/j.jhlto.2026.100689
AB - Lung transplantation (LTx) is an established life-saving therapy for patients with end-stage lung disease. Despite continuous improvements in surgical technique, immunosuppressive regimen and perioperative care, organ shortage remains the principal limitation to broader access. Historically, conservative donor criteria have contributed to the underutilization of potentially transplantable lungs. Over time, lungs from donors outside standard criteria – commonly referred to as extended-criteria donors (ECD) – have been increasingly accepted. This narrative review evaluates contemporary evidence on the experience and outcomes of specific ECD lungs in LTx. We focus first on typically defined ECD including older donor age, smoking history and substance abuse, oxygenation status, radiological abnormalities, microbial colonization, donation after circulatory death, and extended ischemic times. Subsequently, we look at specific donor traits tempering them as emerging ECD. Finally, we evaluate the role and potential benefits of novel preservation and assessment techniques such as controlled hypothermic storage and ex vivo lung perfusion. While accumulating data support the safe use of ECD lungs under appropriate conditions, a paradigm shift toward individualized donor assessment rather than rigid thresholds is mandatory to sustainably expand the donor pool and reduce waitlist mortality.
SN - 2950-1334
ER -