An interpretative review of North American expert consensus on the clinical role of ex vivo lung perfusion (EVLP) with acellular perfusate

This article provides a systematic analysis and commentary on the North American Expert Consensus regarding the clinical role of ex vivo lung perfusion (EVLP) using acellular perfusate. The consensus outlines key recommendations, including general statements on EVLP, criteria for donor lung selection, critical assessment parameters during perfusion, and a decision-making framework for transplantation. It emphasizes that current clinical practice relies heavily on small-scale, non-randomized, single-center studies, which often require substantial reliance on clinical judgment and institutional experience. As a result, the consensus calls for further, more rigorous research to establish evidence-based guidelines for EVLP-related decisions. By integrating the consensus recommendations with recent advancements in both basic and clinical EVLP research, this article examines the clinical relevance of various decision-making criteria and evaluation frameworks. It also explores EVLP management strategies within specific clinical contexts identified in the consensus. Additionally, the article discusses the inherent logistical and economic challenges associated with implementing EVLP in clinical settings. By clarifying both established principles and ongoing controversies, this review aims to bridge the gap between theoretical consensus and clinical practice, and to provide a useful reference for standardizing EVLP protocols, improving donor lung quality, expanding the donor pool, and enhancing transplant outcomes.