Reversal of lung consolidation with mechanical insufflation-exsufflation in a brain-dead lung donor

Shortage of donor lungs for transplantation is largely a consequence of low utilization rates and long waitlists persist despite growth of transplant activities. Low utilization frequently reflects early respiratory complications. We describe a brain-dead potential donor with lung infiltrates and relative hypoxemia, in whom lung suitability for transplantation was restored after airway clearance with mechanical insufflation-exsufflation (MI-E), combined with nebulized hypertonic saline (HS). To our knowledge, this is the first description of effective non-invasive recovery of donor lungs through active secretion mobilization. The low-cost uncomplicated combination of interventions warrants prospective evaluation for inclusion in donor-management protocols.