Lung transplantation from a 94-year-old donor: A debate on biological versus chronological age

Lung transplantation is challenged by a critical shortage of donors, prompting the extension of acceptance criteria, including donor age. Here, we report on a double-lung transplantation from a 94-year-old donor. Despite the advanced age, the lungs were of good physiological quality, with unremarkable gas exchange, bronchoscopy, and radiography. The recipient, a 61-year-old patient with chronic obstructive pulmonary disease, had an uneventful recovery and favorable short-term outcomes but later developed infections and posttransplant lymphoproliferative disease. Lung telomere length analysis revealed a preserved biological reserve, reinforcing the potential to expand the donor pool by prioritizing biological over chronological age, while ensuring graft quality through rigorous evaluation.