Lung transplant continues to be hampered by the number of available donors. Ex-vivo lung perfusion (EVLP) has emerged as an essential tool for the reassessment, under a controlled scenario, of lungs that initially did not meet transplantation criteria. The purpose of the current study is to review the most recent clinical and research reports and summarize their findings. Several centers have presented positive data when using ex-vivo perfusion to identify better grafts from the higher risk donor pool. The posttransplant results, when using these organs, are not significantly different from those obtained when using standard criteria donors. In addition, a great amount of research reports have emphasized the potential of ex-vivo perfusion as a platform in reducing the injurious effects of ischemia-reperfusion. EVLP has already proved its value as a tool to identify 'good' lungs from the previously rejected pool. But as new therapeutics arise , EVLP will also prove its value as a reproducible platform for their evaluation.