“…11 Most potential lung grafts are turned down at the time of evaluation because of concerns about the health of the lungs related to donor history, chest trauma, pneumonia, aspiration, or various ICU complications. 4,[11][12][13] The problem of donor shortage appears to be worse in certain populations, specifically women (primarily thought to be because of shorter stature and a greater incidence of pretransplant allosensitization, making it more difficult to identify suitable donors), 10,[14][15][16] patients with cystic fibrosis (primarily thought to be because of shorter stature and a difference in allocation systems in patients < 12 years of age), 15,17 and patients with idiopathic pulmonary hypertension (primarily because of severity of disease not being captured by pulmonary function testing). 18,19 Four ways in which we think the problem of donor shortage may be improved are: (1) use of more donors after circulatory death to increase the total number of donors, (2) use of extended criteria for donor selection, (3) use of the relatively new technology of ex vivo lung perfusion (EVLP) to increase utilization rate, and (4) utilization of bioengineered lungs.…”