Researchers at the University of Toronto have reported a remarkable shift in how donor lungs are stored before transplantation. In their recent work, they describe a storage method that keeps the lungs at 10 degrees Celsius, rather than the traditional near-freezing temperatures, and show that this approach can dramatically extend the usable life of the organ for transplant. The findings, published in the New England Journal of Medicine, provide compelling evidence that temperature management during preservation plays a crucial role in organ viability and postoperative outcomes. This study adds to a growing body of evidence that rethinking preservation strategies can influence both the logistics of organ allocation and the survival chances of patients awaiting transplantation.
Traditionally, lung preservation has relied on a cold-storage paradigm, maintaining a temperature around four degrees Celsius with continuous ice exposure. Under this regime, lungs can typically be kept viable for roughly eight hours before procurement, transport, and implantation begin to carry a markedly increased risk of complications. The most notable danger is primary graft dysfunction, a serious and sometimes fatal form of injury that occurs in the initial days after transplant. PDT threatens a significant portion of lung recipients and has historically limited the geographic reach of donor lungs, complicating the match process and adding urgency to the transplant timeline.
The Toronto study proposes a different cooling strategy that raises the preservation temperature to 10 degrees Celsius, a shift that appears to stabilize the organ over a much longer window. Over a course of about eighteen months, researchers followed a cohort of 70 patients who received lungs preserved with the new method. Across this group, clinicians monitored a range of postoperative parameters, including oxygen exchange efficiency, inflammatory markers, and early graft performance. Remarkably, none of the recipients developed primary graft dysfunction in the immediate postoperative period, a striking contrast to historical rates observed under conventional storage conditions. While this result is preliminary and must be interpreted within the context of a single-center trial, it suggests that moderate warmth during storage may reduce cellular stress and improve perfusion upon rewarming. The researchers emphasize that further multicenter trials are needed to confirm generalizability, quantify long-term benefits, and determine any potential trade-offs associated with the higher storage temperature.
From a logistical standpoint, the ability to extend lung preservation time has significant implications for the practice of transplantation. Longer storage windows facilitate the transport of lungs across greater distances, enabling more flexible donor-recipient matching and reducing the time pressure that often accompanies organ procurement. For patients on waiting lists, this could translate into more elective, carefully planned surgeries rather than urgent, last-minute interventions. In turn, this may broaden the pool of available donors and improve overall survival for individuals awaiting transplants. The study’s authors point out that while improved preservation can help alleviate some of the organ shortage, it does not lessen the need for comprehensive organ donation campaigns, better recipient selection, or ongoing improvements in immunosuppression and postoperative care. A broader strategy, they argue, will yield the greatest gains in patient outcomes and system-wide efficiency, particularly in health systems across North America where demand remains high and balancing supply with need is an ongoing challenge.
On the topic of impact, leaders in the transplant community have welcomed the findings with cautious optimism. They acknowledge the potential of redefined storage protocols to reshape allocation decisions and increase the likelihood that patients will receive timely, life-saving lungs. Critics note that while the early results are encouraging, replication in diverse clinical settings is essential to ensure consistent performance. They also highlight the importance of rigorous monitoring for unintended consequences, such as changes in preservation-related injuries or shifts in postoperative care requirements. Overall, the momentum generated by this work underscores a broader shift toward evidence-based optimization of every step in the transplant process, from donor evaluation and organ retrieval to long-term recipient monitoring and rehabilitation. The ongoing dialogue among researchers, clinicians, and policy makers will determine how soon such preservation strategies can become standard practice in the United States and Canada, and how they might interact with existing guidelines for organ allocation and utilization, including age and comorbidity considerations. In the meantime, the work adds a powerful data point to the growing argument that temperature-controlled, normothermic, or mildly hypothermic storage methods deserve careful, methodical testing as part of a broader effort to improve transplant viability and patient survival.