{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T14:54:57Z","timestamp":1781880897294,"version":"3.54.5"},"reference-count":51,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T00:00:00Z","timestamp":1753833600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Lung transplantation remains the standard of care for end-stage lung disease, yet a persistent gap exists between donor lung availability and growing clinical demand. Expanding the donor pool and optimising donor lung management are therefore critical priorities. However, no universally accepted management protocols are currently in place. This narrative review examines evidence-based strategies to improve lung utilisation across three donor categories: donors after brain death (DBD), controlled donors after circulatory death (cDCD), and uncontrolled donors after circulatory death (uDCD). A systematic literature search was conducted to identify interventions targeting lung preservation and function, including protective ventilation, recruitment manoeuvres, fluid and hormonal management, and ex vivo lung perfusion (EVLP). Distinct pathophysiological mechanisms\u2014sympathetic storm and systemic inflammation in DBD, ischaemia\u2013reperfusion injury in cDCD, and prolonged warm ischaemia in uDCD\u2014necessitate tailored approaches to lung preservation. In DBD donors, early application of protective ventilation, bronchoscopy, and infection surveillance is essential. cDCD donors benefit from optimised pre- and post-withdrawal management to mitigate lung injury. uDCD donor lungs, uniquely vulnerable to ischaemia, require meticulous post-mortem evaluation and preservation using EVLP. Implementing structured, evidence-based lung management strategies can significantly enhance donor lung utilisation and expand the transplantable organ pool. The integration of such practices into clinical protocols is vital to addressing the global shortage of suitable lungs for transplantation.<\/jats:p>","DOI":"10.3390\/jcm14155380","type":"journal-article","created":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T14:00:41Z","timestamp":1753884041000},"page":"5380","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Strategies for Maximising Lung Utilisation in Donors After Brain and Cardiac Death: A Narrative Review"],"prefix":"10.3390","volume":"14","author":[{"given":"Carola","family":"Pergolizzi","sequence":"first","affiliation":[{"name":"Department of Medical Science, Surgery and Neurosciences, Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, University Hospital of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0131-4450","authenticated-orcid":false,"given":"Chiara","family":"Lazzeri","sequence":"additional","affiliation":[{"name":"Regional Center for Transplant Coordination, 50100 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Marianello","sequence":"additional","affiliation":[{"name":"Department of Medical Science, Surgery and Neurosciences, Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, University Hospital of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7315-8273","authenticated-orcid":false,"given":"Cesare","family":"Biuzzi","sequence":"additional","affiliation":[{"name":"Department of Medical Science, Surgery and Neurosciences, Urgency-Emergency Anaesthesia and Intensive Care Unit, University Hospital of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Casagli","family":"Irene","sequence":"additional","affiliation":[{"name":"Department of Medical Science, Surgery and Neurosciences, Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, University Hospital of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Puddu","sequence":"additional","affiliation":[{"name":"Department of Medical Science, Surgery and Neurosciences, Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, University Hospital of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8351-3703","authenticated-orcid":false,"given":"Elena","family":"Bargagli","sequence":"additional","affiliation":[{"name":"Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University Hospital of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5354-152X","authenticated-orcid":false,"given":"David","family":"Bennett","sequence":"additional","affiliation":[{"name":"Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University Hospital of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2473-8511","authenticated-orcid":false,"given":"Chiara","family":"Catelli","sequence":"additional","affiliation":[{"name":"Thoracic Surgery and Lung Transplant Unit, University Hospital of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Luzzi","sequence":"additional","affiliation":[{"name":"Thoracic Surgery and Lung Transplant Unit, University Hospital of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2267-1337","authenticated-orcid":false,"given":"Francesca","family":"Montagnani","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Infectious and Tropical Diseases Unit, University Hospital of Siena, 53100 Siena, Italy"},{"name":"Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco Del Rio","family":"Gallegos","sequence":"additional","affiliation":[{"name":"Oficina Regional de Coordinaci\u00f3n de Trasplantes, Servicio Madrile\u00f1o de Salud, Consejer\u00eda de Sanidad de la Comunidad de Madrid, 28009 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3709-2052","authenticated-orcid":false,"given":"Sabino","family":"Scolletta","sequence":"additional","affiliation":[{"name":"Department of Medical Science, Surgery and Neurosciences, Urgency-Emergency Anaesthesia and Intensive Care Unit, University Hospital of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriano","family":"Peris","sequence":"additional","affiliation":[{"name":"Regional Center for Transplant Coordination, 50100 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4448-1892","authenticated-orcid":false,"given":"Federico","family":"Franchi","sequence":"additional","affiliation":[{"name":"Department of Medical Science, Surgery and Neurosciences, Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, University Hospital of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1016\/j.ccm.2017.07.007","article-title":"Evaluation and 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