Preservation of the donor heart: from basic science to clinical studies
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Updated: Apr 19, 2026
Author Spotlight: Enhancing Donor Heart Preservation Through Isolated Rat Heart Perfusion Studies
Published on: October 4, 2024
Sarkis M Minasian1, Michael M Galagudza2, Yuri V Dmitriev3
1Institute of Experimental Medicine, Federal Almazov Medical Research Centre, St Petersburg, Russian Federation Department of Pathophysiology, First Pavlov State Medical University of St Petersburg, St Petersburg, Russian Federation.
Insights
Donor heart preservation aims to reduce injury during transport. New methods like machine perfusion and optimized solutions may expand the donor pool by enabling use of hearts from extended criteria donors.
Area of Science:
- Cardiology
- Transplantation Medicine
- Biomedical Engineering
Background:
- Ischaemia-reperfusion injury (IRI) is a major cause of donor heart graft dysfunction during ex vivo transport.
- Current standard heart preservation involves static cold storage in crystalloid heart preservation solutions (HPS), effective for less than 6 hours.
- A growing shortage of donor hearts necessitates development of advanced preservation techniques.
Purpose of the Study:
- To review novel heart preservation solutions and strategies for optimizing existing ones.
- To discuss emerging preservation methods such as machine perfusion and sub-zero temperature storage.
- To explore adjunct therapies like pre- and post-conditioning and reconditioning techniques for donation after circulatory death hearts.
Main Methods:
- Literature review of new heart preservation solution formulations.
- Discussion of advanced preservation techniques including machine perfusion, sub-zero storage, and oxygen persufflation.
- Analysis of experimental data on graft pre- and post-conditioning and reconditioning strategies.
Main Results:
- Various HPS formulations offer comparable myocardial protection against IRI in clinical trials.
- Emerging techniques like machine perfusion show promise for extending preservation times.
- Pre- and post-conditioning, alongside reconditioning methods, can improve graft function and expand donor eligibility.
Conclusions:
- Optimizing HPS composition and exploring novel preservation methods are crucial for addressing donor heart shortages.
- Advanced techniques may enable the use of hearts from extended criteria donors, increasing the overall donor pool.
- Implementing innovative preservation strategies can enhance the viability and utility of donor hearts for transplantation.
Abstract:
The methods of donor heart preservation are aimed at minimizing graft dysfunction caused by ischaemia-reperfusion injury (IRI) which inevitably occurs during the ex vivo transport interval. At present, the standard technique of heart preservation is cardiac arrest followed by static cold storage in a crystalloid heart preservation solution (HPS). This technique ensures an acceptable level of heart protection against IRI for <6 h. In clinical trials, comparable levels of myocardial protection against IRI were provided by various HPSs. The growing shortage of donor hearts is one of the major factors stimulating the development of new techniques of heart preservation. Here, we summarize new HPS formulations and provide a focus for optimization of the composition of existing HPSs. Such methods of donor heart preservation as machine perfusion, preservation at sub-zero temperature and oxygen persufflation are also discussed. Furthermore, we review experimental data showing that pre- and post-conditioning of the cardiac graft can improve its function when used in combination with cold storage. The evidence on the feasibility of cardiac donation after circulatory death, as well as the techniques of heart reconditioning after a period of warm ischaemia, is presented. The implementation of new techniques of donor heart preservation may contribute to the use of hearts from extended criteria donors, thereby expanding the total donor pool.
