Previously, limited cumulative experience has been linked to poor transplantation outcomes following ex vivo lung perfusion (EVLP). We sought to determine if EVLP performed at external perfusion centers (EPC) could mitigate this effect. Recipients from the United Network for Organ Sharing Database were stratified into: high-volume transplant program (HV-TP), low-volume transplant program (LV-TP), and EPC, based on who performed EVLP. Comparative statistics and Kaplan-Meier survival analysis were used, with a multivariable Cox regression model identifying independent mortality risk factors. A subgroup analysis compared LV transplant centers using EPCs (LV-EPC) against HV-TP recipients. The LV-TP group had a significantly higher incidence of postoperative ECMO use (20.8%, p = 0.009) and primary graft dysfunction grade 3 (PGD3) (30.1%, p = 0.011). However, survival did not significantly differ between groups, and LV-TP was not independently associated with increased mortality. Subgroup analysis showed that the LV-EPC had significantly shorter hospital stay when compared with HV-TP (20.5 vs. 24 days, p = 0.01) and equivocal rates of PGD3 ( p = 0.204), with no survival or independent mortality difference on multivariable analysis. External perfusion centers can mitigate postoperative complications associated with LV transplant centers. For centers with limited EVLP experience, EPCs offer a viable alternative pathway to expand the donor pool.

In 2009, the International Building Code (IBC) introduced a new requirement for an additional exit stair or evacuation elevators in buildings (except residential buildings) over 420 ft. (128 m) tall. This new requirement has emerged as a critical innovation in occupant evacuation in supertall buildings, offering the potential for faster egress during emergencies. In the 2018 edition of the IBC, the analysis of full building evacuation with elevators is further required to demonstrate an evacuation time of less than 1 h. This paper examines the implementation of evacuation elevators in accordance with recent building code developments, such as the International Building Code (IBC), Chinese “General Code for Fire Protection of Buildings and Constructions” (GB 55037-2022), and the Korean Building Code (KBC). This study provides a comparative analysis of these regulations, highlighting the evolving acceptance of elevator-based evacuation methods. Since the requirements on means of egress in the codes in China and Korea follow similar concepts in the IBC, case studies of supertall buildings in China and Korea, where evacuation elevators were integrated into the overall egress strategy, are carried out to demonstrate the capability of evacuation elevators in achieving the IBC’s requirement for full evacuation within one hour. Using computer-based egress modeling, the study evaluates practical solutions for reducing evacuation times, exploring factors such as elevator capacity, speed, and coordination with traditional stairwell egress. The results suggest that, while evacuation elevators can significantly improve evacuation efficiency, achieving the one-hour target remains a challenge in complex, high-occupancy environments. The study indicates the importance of optimizing the balance between stair and elevator usage and explores the future role of artificial intelligence (AI) in enhancing evacuation systems.