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Updated: Dec 19, 2025
Large-Animal Model of Donation after Circulatory Death and Normothermic Regional Perfusion for Cardiac Assessment
Published on: May 10, 2022
Machine perfusion of circulatory determined death hearts: A scoping review
Lars Saemann1, Yuxing Guo2, Qingwei Ding2
1Department of Cardiac Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 326, Heidelberg 69120, Germany; Faculty Medical and Life Sciences, Furtwangen University, Jakob-Kienzle-Straße 17, Villingen-Schwenningen 78054, Germany.
Insights
Ex vivo machine perfusion (EVMP) shows promise for donor heart preservation, especially from marginal donors. However, optimal EVMP techniques using blood or crystalloid solutions require further research for heart transplantation.
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Preservation
Background:
- Ex vivo machine perfusion (EVMP) is a viable method for donor heart preservation.
- Marginal donor hearts, including those from non-heart beating donors (NHBD) and donation after cardiac death (DCD), are increasingly considered for heart transplantation (HTx) due to organ shortages.
- Current clinical and preclinical research on EVMP for DCD hearts is promising, but the ideal perfusion strategy remains undefined.
Purpose of the Study:
- To systematically review ex vivo machine perfusion (EVMP) techniques for human and animal donation after cardiac death (DCD) heart preservation.
- To address key questions regarding perfusion solutions, parameters, and target values for EVMP of DCD hearts.
- To compare EVMP with traditional cold static storage (CSS) for DCD heart preservation.
Main Methods:
- A systematic review was conducted following PRISMA extension for Scoping Reviews guidelines.
- The review encompassed all EVMP techniques applied to human and animal DCD hearts.
- Studies were analyzed based on perfusion solutions, parameters, and direct comparisons with cold static storage (CSS).
Main Results:
- The majority of reviewed studies involved animal models.
- Perfusion solutions varied, including crystalloid and blood-based options, with or without cardioplegia, and some supplemented with pharmacological agents.
- Temperatures ranged widely (lowest at 4°C), with normothermic, oxygenated blood perfusion also utilized. Pressure-controlled anterograde Langendorff perfusion was the most common method. Crystalloid EVMP demonstrated superiority over CSS where investigated.
Conclusions:
- Currently, only blood-based EVMP has been implemented in clinical practice.
- Further preclinical and clinical research is essential to establish the optimal EVMP strategy, encompassing both blood and crystalloid-based perfusion approaches.
- Developing standardized EVMP protocols is crucial for improving the utilization of marginal donor hearts in transplantation.
Background:
Ex vivo machine perfusion (EVMP) is reported to can successfully be applied for donor heart preservation. To respond to the organ shortage, some centres also accept hearts from marginal donors such as non-heart beating donors (NHBD) or hearts donated after cardiac death (DCD) for heart transplantation (HTx). Clinical as well as preclinical science on EVMP of DCD hearts seems to be promising but the ideal perfusion practice itself appears unclear.
Objectives:
In accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA), this systematic review scopes all EVMP techniques for human and animal DCD heart preservation and addresses three specific questions, which refer to (a) the perfusion solutions, (b) the perfusion parameters and respective target values and (c) if possible, a direct comparison between cold static storage (CSS) and EVMP.
Results:
Search results predominantly consisted of animal studies. Either perfusion with a crystalloid or blood-based solution, each with cardioplegic or non-cardioplegic properties was used. Some perfusates were supplemented with specific pharmacological medication to block pathophysiological pathways, which are involved in ischemia/reperfusion injury or edema formation. Besides normothermic EVMP with oxygenated blood, a wide range of temperature was applied in all approaches, with the lowest temperature at 4 °C. Pressure controlled anterograde Langendorff perfusion was applied mostly. If investigated, crystalloid machine perfusion was presented superior to CSS.
Conclusions:
Only blood based EVMP was introduced into clinical practice. More research, clinical as well as preclinical, is needed to develop the ideal EVMP technique, in terms of blood or crystalloid perfusion.
