Ex Vivo Lung Perfusion Using Whole Blood: How?

The ex vivo lung perfusion (EVLP) procedure has emerged and established itself as a safe and reliable method for the reconditioning of marginal lung grafts. Many clinical centers worldwide have reported the successful and valuable application of this procedure.1 Preclinical studies have continued further investigations and refining of the technology. One of the main points of discussion and controversy is the nature of the used perfusate, whether it should be whole blood, acellular perfusate, or a mixture of red blood cells and acellular perfusate. Although each point of view has advantages and disadvantages, some published studies and unpub - lished observations have reported a significant benefit of the use of whole blood over red blood cells or acellular perfusates.2,3 This commentary explores the applicability, rather than the evidence-based significance, on the human level.