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Donor Heart Recovery and Preservation Modalities in 2024
Joseph B Lerman1, Richa Agarwal2, Chetan B Patel2
1Duke University Hospital, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA.
Insights
Novel heart preservation methods like ex vivo perfusion improve outcomes in heart transplantation (HT). These techniques overcome limitations of traditional cold storage, expanding donor options and enhancing graft survival.
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Preservation
Background:
- Traditional cold storage for donor hearts carries risks of ischemic and cold-induced injuries, potentially leading to primary graft dysfunction and poorer heart transplantation (HT) outcomes.
- Limitations of cold storage restrict geographic reach for organ procurement and exclude certain donor types.
Purpose of the Study:
- To review emerging evidence on novel donor heart preservation techniques and their association with improved post-HT outcomes.
- To suggest best practices for selecting between different donor heart preservation methods.
Main Methods:
- Review of emerging clinical evidence on novel donor heart preservation modalities.
- Analysis of the impact of controlled hypothermic preservation (e.g., SherpaPak) and ex vivo perfusion (e.g., Transmedics Organ Care System) on HT outcomes.
Main Results:
- Novel preservation techniques are expanding the geographic reach of procurement teams.
- These methods facilitate the use of hearts from donation after cardiac death and expanded criteria donors.
- Emerging evidence suggests improved post-HT outcomes associated with these advanced preservation strategies.
Conclusions:
- Novel donor heart preservation technologies are transforming heart transplantation.
- These advancements offer potential for better graft utilization and improved patient outcomes.
- Evidence-based selection of preservation techniques is crucial for optimizing heart transplantation success.
Abstract:
Historically, heart transplantation (HT) has relied on the use of traditional cold storage for donor heart preservation. This organ preservation modality has several limitations, including the risk for ischemic and cold-induced graft injuries that may contribute to primary graft dysfunction and poor post-HT outcomes. In recent years, several novel donor heart preservation modalities have entered clinical practice, including the SherpaPak Cardiac Transport System of controlled hypothermic preservation, and the Transmedics Organ Care System of ex vivo perfusion. Such technologies are altering the landscape of HT by expanding the geographic reach of procurement teams and enabling both donation after cardiac death and the use of expanded criteria donor hearts. This paper will review the emerging evidence on the association of these modalities with improved post-HT outcomes, and will also suggest best practices for selecting between donor heart preservation techniques.
