Ex-Vivo Lung Perfusion (EVLP): Reviving Damaged Lungs for Transplant

Lung transplantation offers hope to patients with lung disease, but there is a critical shortage of donor organs. Only about 15%-25% of available lungs are typically used for transplantation because many donors are considered damaged or too risky. Ex-vivo lung perfusion (EVLP) has emerged as a game-changing technology that helps solve this problem by giving doctors a way to assess and potentially repair lungs outside the human body before transplantation. As researchers explain, "EVLP employs normothermic perfusion and ventilation techniques to maintain the organ's metabolic functions", essentially keeping the lungs “alive” in a controlled environment. During this process, which can last several hours, transplant teams can closely monitor lung function, treat infections or inflammation, and determine whether the previously rejected lungs are actually suitable for transplantation. The lungs are connected to a machine that circulates a special solution that has nutrients, oxygen, and antibiotics while ventilating them just like they would function in the body.

The technology addresses several critical issues in lung transplantation. Donor lungs often suffer damage from factors like prolonged time without blood flow, fluid accumulation aspiration of stomach contents, or infections. EVLP provides additional time to assess these lungs and watch them improve. Instead of making a quick decision at the donor hospital, surgeons observe the lungs for 4-12 hours and see if their function gets better with treatment received. Recent research has explored multiple ways to enhance EVLP. One breakthrough found that “removing NETs during EVLP improved lung function and morphology in aspiration-damaged donor lungs", demonstrating that specialized treatments during perfusion can repair seriously damaged organs. 

Clinical results have been encouraging and show that lung transplantation after EVLP have similar outcomes to standard donor lungs, with comparable survival rates and no significant increase in complications. This means that EVLP successfully expands the donor pool without compromising patient safety. Despite its promise, EVLP faces challenges including high costs, complex surgery, and specialized equipment and well trained doctors. However, as techniques improve and more people gain experiences, EVLP continues to transform lung transplantation.

by Malak Ibrahim at Incisionary

APA References

Aboelnazar, N., Himmat, S., Freed, D., & Nagendran, J. (2016, September 7). Ex-Vivo Lung Perfusion: From Bench to Bedside. Retrieved November 17, 2025, from https://www.intechopen.com/chapters/51449 intechopen.com (Image)

Nakata, K., Alderete, I. S., Hughes, B. A., & Hartwig, M. G. (2025, February 24). Ex vivo lung perfusion: recent advancements and future directions. Retrieved November 17, 2025, from https://pmc.ncbi.nlm.nih.gov/articles/PMC11891253/ PMC+1

Mittendorfer, M. (2024). Restoring discarded porcine lungs by ex vivo removal… Retrieved November 17, 2025, from https://www.jhltonline.org/article/S1053-2498(24)01736-4/fulltext