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Heart allograft preservation: an arduous journey from the donor to the recipient
Michiel Erasmus1, Arne Neyrink, Mario Sabatino
1aDepartment of Cardiothoracic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands bDepartment of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium cHeart and Lung Transplantation Program, Bologna University Hospital, Bologna Italy.
Insights
Improving heart transplant organ utilization involves optimizing procurement, transport, and recovery. Novel perfusion technologies and donor management enhance the viability of initially unsuitable organs for transplantation.
Area of Science:
- Cardiovascular Surgery
- Organ Transplantation
- Regenerative Medicine
Background:
- Significant gap exists between heart transplant demand and organ availability.
- Current organ utilization can be improved by accepting organs previously deemed unsuitable.
Purpose of the Study:
- To review strategies for optimizing organ utilization in heart transplantation.
- To explore advancements in organ procurement, preservation, and post-transplant recovery.
Main Methods:
- Review of recent studies on donor management and organ preservation techniques.
- Analysis of novel technologies for ex vivo heart perfusion and reconditioning.
Main Results:
- Donor management and novel perfusion technologies are improving organ utilization.
- Extended preservation times and 'resuscitation' of ischemic hearts are now feasible.
- Graft reconditioning using assist devices aids post-transplant function.
Conclusions:
- Heart preservation during procurement, transport, and transplant has significantly improved.
- Future efforts should focus on healing unsuitable organs and ensuring cost-effectiveness of new technologies.
Purpose Of Review:
The discrepancy between needs and availability of organs for heart transplantation may be partially reduced by improving the utilization of organs currently deemed unsuitable. Strategies to achieve this goal need optimization of the entire process of organ procurement, transportation, and functional recovery after transplant.
Recent Findings:
In the latest years, several studies reported improvements in organ utilization after appropriate donor management, and management of heart transportation is approaching a new era. In particular, apart from perfecting of traditional cold static preservation techniques, novel technologies now allow continuous heart perfusion prolonging out-of-body times, and prompted to the 'resuscitation' of hearts injured by the warm ischemia of circulatory death donors. The accomplishment of the journey needs appropriate protection of the graft during and after the transplant surgery. This concept is driven by adequate donor-recipient matching and aided by the assist devices that, mimicking organ perfusion machines, may allow graft reconditioning while maintaining recipient's peripheral organ function.
Summary:
The researches reviewed in this article support a significant improvement of the heart preservation during the multifaceted process of procurement, transport, and transplant. Future challenges will be to develop healing of currently unsuitable organs, while keeping the cost of technology within the borders of affordability for healthcare systems.
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