DONOR ORGANS ARE A VALUABLE BUT SCARCE REsource that provide a lifesaving procedure to thousands of patients per year. However, the demand for organs of all types far exceeds supply. In 2009, 50 463 patients were added to the United Network for Organ Sharing’s wait list, 28 463 patients received an organ transplant, and 6683 patients died while waiting for a suitable organ. Despite substantial effort and research devoted to improving donation rates in the United States, these rates remain substantially lower than those in many other developed countries. Many techniques such as implied consent, opt-out policies, breakthrough collaborative and quality improvement methods, and financial incentives have been proposed to expand the pool of organ donors. Two articles in this issue of JAMA present important information about this problem and provide simultaneously sobering and encouraging insights into strategies to improve the supply of organs. The randomized controlled trial by Mascia and colleagues compared the conventional ventilatory method used for potential lung donors with a lung preservation (protective) strategy from the time of brain death. The protective strategy included lower tidal volumes, higher positive endexpiratory pressure, alveolar recruitment maneuvers after any ventilator disconnection, and the use of continuous positive airway pressure during apnea tests. This study breaks important new ground in providing a solid evidence base for the care of potential organ donors and testing techniques of organ preservation. The surgeons evaluating the organs for transplant suitability were blinded to the ventilation strategy (conventional vs protective) and all outcomes (including organ donations other than the lung) were followed up. The results of the study are profound. The protective strategy nearly doubled the number of eligible lungs at 6 hours (32 patients [54%] in the conventional strategy vs 56 patients [95%] in the protective strategy) and doubled the number of patients from whom lungs for transplant were harvested (lungs from 16 patients [27%] in the conventional strategy vs 32 patients [54%] in the protective strategy). Furthermore, although the numbers are small, there appears to be no detrimental effect of the protective strategy on transplant outcomes, either with the lungs or with other organs that were harvested at the same time. The secondary analyses provide evidence of a mechanistic reason as well. Levels of several inflammatory cytokines were significantly elevated among patients in the conventional strategy group. These results are encouraging for several reasons. First, they demonstrate that in a cohort of patients who have already consented to be organ donors, the rate of viable organ procurement was doubled. In the context of lung transplantation, this has the potential to help eliminate the disparity between demand and supply. In 2009, 2234 candidates were added to the lung transplant waiting list and there were 1568 lung donors. Doubling that donation rate could potentially meet steady-state demand as well as reduce waiting-list backlog, especially because each donor provides organs for more than 1 transplant. Second, although the sample size of the study by Mascia et al is small, there appears to be no detrimental effect on transplantation outcomes of either the transplanted lung or the other organs obtained from the donor. Third, this study has set the methodological bar regarding how such organ donor preservation studies should be conducted and demonstrated that such high-quality, controlled, and mechanistically informative studies are possible in the transplantation setting. However, the protective ventilation strategy is specific to lungs for transplantation, and further studies are needed to determine whether tailored preservation strategies will increase the viability of other organs. The report by Halpern and colleagues evaluates the potential effect of a more complete use of organ donation af-