BACKGROUND Over the past 15 years, the number of recipients waiting for a lung transplant has increased and now far exceeds the number of available donors. Liberalization of donor criteria to include the use of extended donors remains an attractive option for expanding the donor pool. Numerous centers, including the authors' own, have begun exploring this relatively unknown territory of lung transplantation. CASE REPORT Successful bilateral lung transplantation was performed for a patient with emphysema utilizing lungs from a donor with persistent lobar atelectasis. CONCLUSION This report demonstrates that an acceptable outcome is possible from a donor with persistent lobar atelectasis if other parameters are acceptable. Larger studies would help further our understanding of the impact of donor radiographic abnormalities on outcomes following lung transplantation.