Lungs from brain-dead or deceased donors are considered unusable 85% of the time, worsening waiting-list times and death rates. At a single Toronto center, Cypel et al perfused damaged donor lungs ex-vivo (EVLP; here’s how) for 4 hours, and if their numbers were good (PaO2/FiO2 > 349; less than 15% worsening in compliance, pulmonary vascular resistance and peak inspiratory pressure), transplanted the lungs. Of 23 high-risk donor lung sets, 20 passed that test and were grafted. Primary graft dysfunction at 72 hours was 15% in the EVLP group (none severe), vs. 30% in the standard care group (9% severe). There were no severe adverse events. One-year survival was 80% (ex-vivo lung perfusion) vs 83.6% (control), p=0.54. NEJM 2011;364:1431-1440.