ISHLT Consensus Statement on the Perioperative Use of ECLS in Lung Transplantation

Published 1 January 2026

• Advanced Lung Failure & Transplantation
• Anesthesiology & Critical Care
• Consensus Document
• Nursing & Allied Health
• Pediatrics
• Pharmacy
• Publications & Journals
• Pulmonology
• Standards & Guidelines

The use of extracorporeal life support (ECLS) throughout the perioperative phase of lung transplantation requires nuanced planning and execution by an integrated team of multidisciplinary experts. To date, no multidisciplinary consensus document has examined the perioperative considerations of how to best manage these patients. To address this challenge, this perioperative utilization of ECLS in lung transplantation consensus statement was approved for development by the International Society for Heart and Lung Transplantation Standards and Guidelines Committee. International experts across multiple disciplines, including cardiothoracic surgery, anesthesiology, critical care, pediatric pulmonology, adult pulmonology, pharmacy, psychology, physical therapy, nursing, and perfusion, were selected based on expertise and divided into subgroups examining the preoperative, intraoperative, and postoperative periods. 

Following a comprehensive literature review, each subgroup developed recommendations to examine via a structured Delphi methodology. Following 2 rounds of Delphi consensus, a total of 39 recommendations regarding intraoperative considerations for ECLS in lung transplantation met consensus criteria.

Part I: Preoperative Considerations

J Heart Lung Transplant. October 2025.

Authors

Anna Reed, MD, PhD; Olaf Mercier, MD, PhD; Juergen Behr, MD, PhD, Kavita Dave, MD; Göran Dellgren, MD, PhD; Sakhee Kotecha, MD; Jasleen Kukreja, MD, PhD; Caroline Landry, CPC, MSc, Bronwyn Levvey, PhD; Haifa Lyster, PhD; Orla Morrissey, MD, PhD; Siavosh Saatee, MD; Melissa Sanchez, DClinPsy; Marc Schecter, MD; James Walsh, PhD; Ashley Fritz, DO; Theresa Gelzinis, MD; Konrad Hoetzenecker, MD, PhD; Sandra Lindstedt, MD, PhD; Nandor Marczin, MD, PhD; Barbara Wilkey, MD; Julien Fessler, MD; Brandi Bottiger, MD; Keith Wille, MD; Basil Nasir, MD; David Gomez-De-Ontonio, MD; Marcelo Cypel, MD, PhD; Archer Martin, MD

Focusing on recommendations for patient selection, planning for bridging initiation and supportive strategies, management during the bridging period, prevention and management of complications, and considerations for future research and technological development for ECLS as bridge to lung transplantation.

Part II: Intraoperative Considerations

J Heart Lung Transplant. October 2024.

Authors

Archer Martin, MD; Olaf Mercier, MD, PhD; Ashley Virginia Fritz, DO; Theresa A. Gelzinis, MD; Konrad Hoetzenecker, MD, PhD; Sandra Lindstedt, MD, PhDf; Nandor Marczin, MD, PhD; Barbara J. Wilkey, MD; Marc Schecter, MD; Haifa Lyster, PhD; Melissa Sanchez, DClinPsy; James Walsh, PhD; Orla Morrissey, MD, PhD; Bronwyn Levvey, PhD; Caroline Landry, CPC, MSc; Siavosh Saatee, MD; Sakhee Kotecha, MD; Juergen Behr, MD, PhD; Jasleen Kukreja, MD, PhD; Göran Dellgren, MD, PhD; Julien Fessler, MD; Brandi Bottiger, MD; Keith Wille, MD; Kavita Dave, MD; Basil S. Nasir, MD; David Gomez-De-Antonio, MD; Marcelo Cypel, MD, PhD; Anna Reed, MD, PhD

Focusing on on presurgical planning for intraoperative implementation, intraoperative management, and considerations for future research and technological development for ECLS in lung transplantation.

Part III: Postoperative Considerations

J Heart Lung Transplant. June 2025.

Authors

Archer Martin, MD; Olaf Mercier, MD, PhD; Brandi Bottiger, MD; Marcelo Cypel, MD, PhD; Julien Fessler, MD; David Gomez-De-Antonio, MD; Bronwyn Levvey, PhD; Haifa Lyster, PhD; Basil Nasir, MD; Melissa Sanchez, DClinPsy; Keith Wille, MD; Ashley Virginia Fritz, DO; Theresa Gelzinis, MD; Konrad Hoetzenecker, MD, PhD; Kavita Dave, MD; Sandra Lindstedt, MD, PhD; Nandor Marczin, MD, PhD; Barbara Wilkey, MD; Marc Schecter, MD; James Walsh, PhD; Orla Morrissey, MD, PhD; Caroline Landry, CPC, MSc; Siavosh Saatee, MD; Sakhee Kotecha, MD; Juergen Behr, MD, PhD; Jasleen Kukreja, MD, PhD; Göran Dellgren, MD, PhD; Anna Reed, MD, PhD

Focusing on criteria for postoperative implementation, organ-system based MDT management, and considerations for future research and technological development for ECLS in lung transplantation.

Perspectives Piece

The ISHLT Perspective Piece is a new document type developed to accompany all ISHLT Documents and is specifically designed for print publication in JHLT. The piece The piece will set the context for the document in an easy-to-read manner and serves as an opportunity for writing groups to speak directly to the heart and lung transplant community about the rationale behind each document, its most important takeaways, and the hard work that went into creating it.