Donor lungs, like all ventilated lungs, are at risk of developing atelectasis. The second lung management pearl gleaned from the critical care literature discussed in Bansal et al’s5 review of donor lung management is lung recruitment and the importance of PEEP. Lung protective strategies have the potential to lead to lung derecruitment, and, thus, recruitment maneuvers and optimal PEEP settings are components of many ventilator management strategies in the ICU.10,11 These maneuvers potentially increase aerated lung units, which may decrease ventilator-associated lung injury and improve oxygenation by decreasing shunt. However, this benefit may be counterbalanced by the risk of alveolar overdistention caused by excessive pressures, volumes, or both.12 One potential way to mitigate this risk is by measuring the stress index at the bedside.13 Although the stress index has not been validated as a clinical marker to prevent injury, it has been examined as a tool to assess lung overdistention in patients who have been mechanically ventilated.14 The stress index can be measured using the pressure-time display at the bedside, providing real-time clinically useful information to screen for overdistension. Thus, although addressing atelectasis/recruitability is important and potentially beneficial in the management algorithm of potential donors, one must concomitantly avoid unrecognized lung injury. Optimal recruitment maneuvers and PEEP levels in donors have not been identified at this point, and some care should be taken to avoid excessive pressures and/or volumes because lung heterogeneity is well described.