Patient selection
All patients were listed for transplant after being reviewed by a multidisciplinary team in accordance with the current guidelines. As recommended by our Institutional Ethics Committee, all patients on the LTx waiting list were additionally consented for LTx from DCD donors. Donors were selected based on the current standard ISHLT criteria including extended donor criteria.15 Preoperative VV-ECMO was considered as a BTT in patients who were already listed for LTx, have suffered acute decompensation in their end-stage lung disease and continued to deteriorate despite standard medical treatment, non-invasive or invasive mechanical ventilation (MV). Further considerations for BTT included intact neurological status, the absence of active bacteremia or organ failure, and the potential to participate in pretransplant physical therapy. Donor lung assessment, procurement and preservation were described earlier by our group.16-18