Edward Cantu, MD, describes the ex vivo lung perfusion (EVLP) program at Penn Medicine. ELVP is used to enhance donor lung evaluation for transplantation in suboptimal organs not ordinarily used for transplantation. Penn Medicine was the first in the region to incorporate this new technique into lung transplantation surgeries. Dr Cantu explains the selection process for both ELVP donor lungs and recipients, technical and monitoring requirements and survival and secondary outcomes at Penn Medicine. Other topics include primary graft dysfunction, the evolving parameters for risk, prognostic factors and ongoing and approaching clinical trials.