Donor risk prediction: How 'extended' is safe?

Purpose of review: This article reviews recent developments in the selection of the lung donor that aim to increase donor organ use. The scarcity of suitable donor organs continues to limit lung transplantation resulting in long waiting times and significant mortality for those patients awaiting transplantation. Recent findings: Strategies to expand the donor pool can substantially lift donor lung utilization rates from historically low levels of less than 15% to rates greater than 50% without inordinate risk of short-term or long-term complications. Numerical donor and recipient scores may have a significant role to play in measuring, comparing and contrasting lung transplant outcomes in future studies of donor variables. Summary: After considering the evolution of lung donor and recipient management practices, in 2013 the available evidence suggests that the traditional factors defining a lung as 'extended', do not actually compromise outcomes within the framework of current management strategies. Extended donor lungs are safe.