March 10, 2026
According to the United Network for Organ Sharing (UNOS), an estimated 1,000 people in the United States are currently waiting for a lung transplant, and only 20% of donor lungs meet the standard for transplantation. To safely expand the pool of available organs, Mayo Clinic Transplant Center is using ex vivo lung perfusion (EVLP). This novel procedure enables lung transplant surgeons to examine donor lungs outside the body for circulation, oxygenation and compliance with greater sensitivity and specificity than ever before.
"Lungs are some of the most fragile and difficult organs to transplant, and assessing the quality of lungs for transplantation is difficult to do remotely," says Jonathan D'Cunha, M.D., Ph.D., chair of Cardiothoracic Surgery and surgical director of the Lung Transplant Program at Mayo Clinic in Arizona. "In reality, it's quite possible that many more organs would be considered suitable with a more thorough exam. EVLP could expand the number of lungs available for transplant by a significant amount."
Lung transplantation is a lifesaving option for individuals with certain types of end-stage lung disease, but more than 300 people die waiting for lung transplant surgery each year. At Mayo Clinic campuses in Arizona, Florida and Minnesota, transplant surgeons and physicians are using EVLP to reduce wait times and improve access to lung transplant.
How EVLP works
During EVLP, a lung is removed from its donor, isolated and sewn onto a circuit where it is resuscitated and perfused in the same manner as inside the body. During the procedure, the lungs are ventilated at specific intervals. Transplant surgeons monitor the organs' gas exchange, airways, contraction and expansion, and in some instances, they remove fluid. Once surgeons are confident that the donor lungs are suitable for surgery, the lungs are placed in a hypothermic cooler and transplant surgery begins.
The EVLP program at Mayo Clinic benefits from a physician-led approach that provides patients with a high level of expertise and confidence in their new lungs.
"Our patients benefit from this additional oversight. Lung transplant surgery is a high-risk procedure and complications can be devastating," says Dr. D'Cunha. "With our EVLP program, thousands of hours of cumulative transplant experience are involved in the evaluation of donor lungs before surgery."
Enhanced evaluation of donor lungs
Nearly half of all organs from deceased donors come from donation after circulatory death. With just millimeters to spare when dividing the heart and lungs for transplant surgery, strictly mandated time limits, and remote evaluation often required, recovery can become complicated. EVLP helps reduce uncertainty about organ suitability and surgical margins, while enhancing clinical judgment.
By allowing for a more detailed evaluation of donor lungs through perfusion, the procedure provides surgeons with the tools needed to ensure that fewer viable organs are passed over. In addition, it helps experts better predict whether donor lungs will be successful in transplant.
"EVLP provides our team with a functional evaluation unlike any other tool we have available," says Dr. D'Cunha. "Through this process, we can see how organs function in real time. A good lung on EVLP is a good lung for transplant. We don't have that feedback otherwise."
Better coordination of transplant surgeries
In addition to a more thorough and functional evaluation of donor lungs, EVLP can safely extend the time between organ recovery and transplantation. This enables surgeons to accept donor lungs and maintain their health and function until transplant surgery can take place.
"EVLP allows us to accept and perform consecutive transplants when we have multiple donor organs and recipients," says Dr. D'Cunha. "By shifting logistics and optimizing manpower, we can help as many patients as possible."
The future of lung transplants with EVLP
Currently, the procedure does not treat donor lungs, but Dr. D'Cunha envisions a future for EVLP beyond organ evaluation. Possible applications for the technology include treating donor lungs for diseases such as pneumonia with antibiotics, using clot-busting medications, and regenerating tissue with stem cells.
"The Mayo Clinic transplant team is committed to expanding the number of lungs available for patients," says Dr. D'Cunha. "EVLP is changing the approach of our transplant surgeons in the operating room. It's a step forward in everything we do in transplantation."
For more information
Refer a patient to Mayo Clinic.