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Updated: Jul 8, 2026
Innovative Strategies for Organ Preservation in Heart Transplantation: Uniform Cooling Preservation and Ex-situ Normothermic Perfusion
Published on: November 28, 2025
[Donor heart preservation]
Yukio Hayashi1, Mitsuo Iwasaki
1Department of Anesthesiology, Osaka University Medical School, Suita.
Insights
Maintaining donor heart function after brain death is crucial for successful transplantation. Volatile anesthetics may protect cardiac function following brain death through preconditioning effects.
Area of Science:
- Anesthesiology
- Cardiovascular Physiology
- Organ Transplantation
Context:
- Severe heart failure necessitates heart transplantation, but donor organ shortage is a major challenge.
- Anesthesiologists play a vital role in maintaining donor organ viability before harvest.
- Brain death often leads to cardiac dysfunction, compromising organ quality.
Purpose:
- To investigate the effects of experimental brain death on cardiac function in a rat model.
- To explore the potential of volatile anesthetics to mitigate cardiac dysfunction post-brain death.
Summary:
- Experimental brain death in rats, induced by intracranial balloon inflation, led to early decreases in ejection fraction and dP/dt max, preceding significant blood pressure drops.
- Myocardial sensitivity to epinephrine was heightened after brain death.
- Volatile anesthetics, known for preconditioning effects, are hypothesized to improve cardiac function in brain-dead donors.
Impact:
- This research may lead to improved anesthetic management strategies for organ donors.
- Understanding brain death-induced cardiac changes can enhance donor organ preservation protocols.
- Identifying interventions to maintain cardiac function could increase the availability of viable donor hearts for transplantation.
Abstract:
Heart transplantation is a common procedure for patients with severe heart failure and shortage of donor organs is a significant problem even in Europe and USA. We, anesthesiologists, contribute to transplantation by anesthetic management of a donor and it is essential to maintain cardiac function until the organ harvest for successful organ transplantation. Since cardiac dysfunction occurrs following brain death, it is clinically important to find some interventions to maintain the cardiac function or to delay cardiac deterioration following brain death. We investigated the cardiac function following experimental brain death in rats. Experimental brain death was induced by inflating intracranial balloon. Ejection fraction and dP/dt max significantly decreased earlier than significant blood pressure reduction after brain death. In addition, myocardial sensitization to epinephrine was enhanced following brain death. Preconditioning is a unique phenomenon to prevent cardiac function from ischemic insult. Volatile anesthetics, including sevoflurane and isoflurane, have similar effects in preconditioning. We expect volatile anesthetics to improve cardiac function following brain death due to preconditioning effect.
