Scientific and Technical Considerations of the World's First Beating Heart Transplantation in a Human: An Operator's...

Heart transplantation remains limited by donor shortage and ischemia-reperfusion injury. While normothermic machine perfusion reduces cold ischemia, maintaining continuous perfusion during implantation remains challenging.

A 67-year-old man with end-stage nonischemic cardiomyopathy underwent the world's first clinical ischemia-free beating heart transplantation using a customized perfusion system that maintained continuous coronary perfusion and electromechanical activity from donor explantation to recipient implantation. The procedure was technically successful, with excellent graft function, although the patient experienced transient metabolic complications postoperatively.

This case demonstrates that beating heart transplantation is technically feasible and eliminates ischemia-reperfusion injury, a fundamental limitation of conventional transplantation and existing perfusion technologies. The procedure represents a paradigm shift from organ preservation to organ sustainment, offering new possibilities for marginal donor use.

Ischemia-free beating heart transplantation is feasible and may redefine graft preservation in cardiac transplantation. Future integration with blood purification technologies and portable perfusion systems could enable long-distance organ transport and expand the donor pool.