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Updated: Jan 18, 2026
Innovative Strategies for Organ Preservation in Heart Transplantation: Uniform Cooling Preservation and Ex-situ Normothermic Perfusion
Published on: November 28, 2025
Understanding donor heart preservation: Cellular mechanisms and clinical outcomes
Yaagnik Kosuri1, Morgan K Moroi1, Sebastian Johannes Bauer1,2
1Department of Surgery, Columbia University, New York, NY, USA.
Insights
Static cold storage for heart transplants causes damage, limiting donor organ availability. New preservation methods show promise for extending preservation times and improving outcomes.
Area of Science:
- Cardiology
- Transplantation Biology
- Organ Preservation
Background:
- Static cold storage (SCS) is the standard for heart preservation but limits donor heart travel radius due to ischemic damage.
- Prolonged cold ischemia increases the risk of primary graft dysfunction, contributing to donor organ shortages.
Purpose of the Study:
- To explore the biological basis of donor heart preservation methods.
- To characterize cellular and molecular mechanisms of SCS, SherpaPak, Organ Care System, and XVIVO Heart Perfusion.
- To review outcomes of Hypothermic Oxygenated Perfusate (HOPE) preservation.
Main Methods:
- Review of existing knowledge on ischemic reperfusion injury in donor hearts.
- Characterization of cellular and molecular mechanisms of various heart preservation systems.
- Description of preclinical and clinical outcomes for HOPE preservation.
Main Results:
- Static cold storage is associated with ischemic damage and reperfusion injury.
- Novel preservation systems demonstrate potential for extending ischemic time beyond the standard 4-6 hours.
- Limited understanding exists regarding the biological mechanisms of newer preservation systems.
Conclusions:
- Advancements in heart preservation beyond SCS are crucial for overcoming donor organ limitations.
- Further research into the biological mechanisms of novel preservation techniques is needed.
- Hypothermic Oxygenated Perfusate (HOPE) preservation shows promise in preclinical and clinical settings.
Abstract:
Static cold storage (SCS) on ice has remained the gold standard preservation method for heart transplantation, and prolonged cold ischemia outside the typical 4-6 hour window is associated with an increased risk of primary graft dysfunction - a consequence attributed to ischemic damage and reperfusion injury. This, unfortunately limits the travel radius for donor heart procurement, a key factor that contributes to the overall shortage of donor organs. Recent research and clinical data have illustrated the validity of other preservation systems in preserving cardiac allografts, and many of these devices have shown promise in potentially prolonging the tolerated ischemic time beyond the accepted standard. Unfortunately, little is known regarding the biological basis of these preservation systems. In this review, we explore the existing knowledge of ischemic reperfusion injury as it relates to the donor heart. We also focus on characterizing the cellular and molecular mechanisms underlying existing donor heart preservation methods, including SCS, Paragonix' SherpaPak, TransMedics' Organ Care System, and XVIVO Heart Perfusion System, highlighting current limitations and areas for improvement. Furthermore, we describe the preclinical and clinical heart transplant outcomes related to Hypothermic Oxygenated Perfusate (HOPE) preservation.
