To evaluate the lung function of donors after circulatory deaths (DCDs), ex vivo lung perfusion (EVLP) has been shown to be a valuable method. We present modified EVLP where lung atelectasis is removed, while the lung perfusion is temporarily shut down. Twelve pigs were randomized into two groups: modified EVLP and conventional EVLP. When the lungs had reached 37°C in the EVLP circuit, lung perfusion was temporarily shut down in the modified EVLP group, and positive end-expiratory pressure (PEEP) was increased to 10？cm H2O for 10 minutes. In the conventional EVLP group, PEEP was increased to 10？cm H2O for 10 minutes with unchanged lung perfusion. In the modified EVLP group, the arterial oxygen partial pressure (PaO2) was 18.5 ± 7.0？kPa before and 64.5 ± 6.0？kPa after the maneuver ( ). In the conventional EVLP group, the PaO2 was 16.8 ± 3.1？kPa and 46.8 ± 2.7？kPa after the maneuver ( ; ). In the modified EVLP group, the pulmonary graft weight was unchanged, while in the conventional EVLP group, the pulmonary graft weight was significantly increased. Modified EVLP with normoventilation of the lungs without ongoing lung perfusion for 10 minutes may eliminate atelectasis almost completely without harming the lungs. 1. Introduction Lung transplantation continues to be hampered by the number of available donors [1, 2]. Ex vivo lung perfusion (EVLP) has emerged as an essential tool for the reassessment, under a controlled scenario, of lungs from heart-beating donors (HBDs) that initially did not meet transplantation criteria [3–8]. The method is also an excellent tool for reassessing lungs of donors after cardiac death (DCD) [9, 10]. The use of DCD lungs has gained much interest lately. DCDs are classified according to the Maastricht classification and may be subdivided as controlled and uncontrolled [11]. Often the controlled DCDs are of interest since these patients are under hospital care, and their clinical history and lung function are known. It is also logistically easier to handle these donors. These controlled donors are, however, limited in number compared with the potential numbers of uncontrolled DCDs. The disadvantage of using lungs from uncontrolled donors, however, is that lung function is not known and has to be validated before the lungs can be accepted for transplant. There are also some issues regarding the optimal preservation of uncontrolled donor lungs such as how long warm ischemic time the lungs can withstand and whether it is better to harvest the lungs after the period of warm ischemia or cool the lungs inside the deceased body. These
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