Sponsor: XVIVO Perfusion, Göteborg Sweden. Completion date of the trial: April 2013.This report will describe the first prospective and multicenter clinical trial using ex vivo lung perfusion (EVLP) as a mean to identify “good” grafts from the substandard donor pool. The main goal of this trial is to define EVLP safety by comparing results between ex vivo evaluated and standard criteria lungs. The trial hypothesis is that the ex vivo selected lungs will have equivalent post-transplant outcomes to standard criteria lungs.This is a phase 1, prospective, non-randomized, and multicenter clinical trial (six U.S. centers). Recruitment is set to stop once 42 transplants after ex vivo lung evaluation (study arm) have been included and matched to 42 contemporary transplants using standard criteria lungs (control arm). To this date, 28 transplants after ex vivo evaluation and 28 using standard criteria donors have been included. Donor inclusion criteria (EVLP arm): At the time of the clinical evaluation, the PaO2/FiO2 ≤ 300mmHg; If PaO2/FiO2 > 300mmHg and the donor has any one or more of the following donor risk factors:–Multiple blood transfusions.–Pulmonary edema detected via CXR, bronchoscopy or palpation of lungs.–Donation after cardiac death donors.–Investigator evaluation of donor lung as “unsuitable” for standard criteria for lung transplant.–Donor exclusion criteria:–Donor lung has pneumonia and/or persistent purulent secretions on bronchoscopy.–Donor has aspirated gastric contents in to the lung.–Donor lung has significant mechanical lung injury or trauma.–Donor lung has active infectious disease such as HIV, Hepatitis B or C, HTLV or Syphilis.30 day mortality. Secondary outcomes:–PGD scores at 0, 24 and 72 hours.–Length of ICU stay post transplant.–Ventilator status and extra-corporeal membrane oxygenator status 7 days after transplant.–12-month subject’s survival status.