From preservation to repair: Mitochondrial transplantation as a paradigm shift in organ transplantation

Organ transplantation faces a persistent mismatch between the number of available donor organs and the growing demand for transplants. Conventional preservation techniques primarily focus on delaying deterioration rather than actively restoring organ function, especially at the mitochondrial level, a key site of injury during ischemia-reperfusion. Mitochondrial transplantation, a novel regenerative strategy, offers a compelling solution by delivering viable mitochondria to damaged tissues ex vivo, particularly during machine perfusion. This approach not only improves bioenergetic recovery and reduces oxidative stress but also reconditions marginal organs to meet transplantation standards. Preclinical studies across heart, lung, and kidney models demonstrate the potential of mitochondrial transplantation to bridge preservation and repair, expanding the transplantable organ pool. This review highlights mitochondrial transplantation as a transformative intervention poised to reshape the future of organ preservation and transplant viability.