Size matching in lung transplantation: new alternatives to an old problem

Current allocation of lungs is based on prioritizing candidates based on a risk benefit ratio. Since the current algorithm does not account for recipient size, waitlist candidates with short stature may wait longer for optimal organs resulting in waitlist mortality. Understanding the pitfalls of lung volume measurements, complications of size mismatch and alternate options for optimizing size may help us better utilize the donor pool. With the advent of ex vivo lung perfusion systems the donor supply is expected to slowly increase. Despite this, concerns with size matching will remain. Finding alternate options such as lobar lung transplant may be a reasonable option for these patients. While lobar lung transplant may not be equivalent to size matched grafts it will continue to be a viable option for those waiting with continued functional decline.