The shortage of organ donors remains the major limiting factor in lung transplant, with the number of patients on the waiting list largely exceeding the number of available organ donors. Another issue is the low utilization rate seen in some types of donors. Therefore, novel strategies are continuously being explored to increase the donor pool. Advanced age, smoking history, positive serologies, and size mismatch are common criteria that decrease the rate of use when it comes to organ utilization. Questioning these limitations is one of the purposes of this review. Challenging these limitations by adapting novel donor management strategies could help to increase the rate of suitable lungs for transplantation while still maintaining good outcomes. A second goal is to present the latest advances in organ donation after controlled and uncontrolled cardiac death, and also on how to improve these lungs on ex vivo platforms for assessment and future specific therapies. Finally, pushing the limit of the donor envelope also means reviewing some of the recent improvements made in lung preservation itself, as well as upcoming experimental research fields. In summary, donor lung optimization refers to a global care strategy to increase the total numbers of available allografts, and preserve or improve organ quality without paying the price of early-, mid-, or long-term negative outcomes after transplantation.

器官供体短缺仍然是肺移植的主要限制因素，等待名单上的患者数量大大超过了可用器官供体的数量。另一个问题是某些类型的捐助者使用率低。因此，正在不断探索新的策略以增加供体库。高龄、吸烟史、阳性血清学和大小不匹配是降低器官利用率的常见标准。质疑这些限制是本次审查的目的之一。通过采用新的供体管理策略来挑战这些限制可能有助于提高适合移植的肺的比率，同时仍保持良好的结果。第二个目标是展示受控和不受控制的心脏死亡后器官捐献的最新进展，以及如何在离体平台上改善这些肺以进行评估和未来的特定治疗。最后，推动供体信封的极限还意味着回顾最近在肺保护本身方面取得的一些改进，以及即将到来的实验研究领域。总之，供体肺优化是指一种全球护理策略，旨在增加可用同种异体移植物的总数，并在不为移植后的早期、中期或长期负面结果付出代价的情况下保留或改善器官质量。推动供体信封的极限也意味着审查最近在肺保护本身方面取得的一些改进，以及即将到来的实验研究领域。总之，供体肺优化是指一种全球护理策略，旨在增加可用同种异体移植物的总数，并在不为移植后的早期、中期或长期负面结果付出代价的情况下保留或改善器官质量。推动供体信封的极限也意味着审查最近在肺保护本身方面取得的一些改进，以及即将到来的实验研究领域。总之，供体肺优化是指一种全球护理策略，旨在增加可用同种异体移植物的总数，并在不为移植后的早期、中期或长期负面结果付出代价的情况下保留或改善器官质量。