Current strategies in donor selection and management.

Lung donor selection and management strategy continues to evolve, driven by the scarcity of donor lungs suitable for transplantation and the ever present risk of primary graft dysfunction. Selection, based both on data available at referral and that added by the retrieval team, was traditionally based on the transplant surgeon's clinical experience. Closely analyzed clinical data on factors such as age, gas exchange, gram-stain, and even cytokine expression now allow increased objectivity of decision making. By contrast, the importance of variables such as length of ventilation and even ischemic time remain obscure. Optimal management, the key to promoting the marginal lung toward the ideal, is soundly based on the rapidly increasing appreciation of the pathophysiology of brain-stem death. Algorithms based on this knowledge can be proposed with some confidence, but proving their clinical worth is a challenge for the future.