Rib trauma poses a significant challenge during lung procurement, particularly in donors with a history of cardiopulmonary resuscitation (CPR) or thoracic injury. Fractured ribs can lacerate the underlying pleura or lung parenchyma, leading to pneumothorax, hemorrhage, or localized contusion, all of which may compromise graft quality. Careful inspection during procurement is essential to identify and manage any parenchymal injuries or hematomas. Surgeons must exercise meticulous technique while opening the chest, often preferring a median sternotomy to avoid exacerbating existing rib fractures. If rib trauma is present, efforts should be made to preserve lung integrity by avoiding manipulation in injured areas, controlling any bleeding, and, when necessary, resecting devitalized tissue to optimize the quality of the allograft.
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