New Perfusion and Preservation Strategies for Donor Hearts

Area of Science:

• Cardiovascular Surgery
• Transplantation Medicine
• Medical Device Technology

Background:

• The standard method for heart procurement and transportation is hypothermic transport of the cardioplegic heart, established in the 1980s.
• This technique yields reproducible, good results but has a critical ischemic time limit of approximately 4-5 hours.
• Novel preservation and transport techniques aim to extend organ ischemic tolerance, showing promise in recent studies.

Purpose of the Study:

• To compare current and novel systems for heart organ procurement and transportation.
• To evaluate the effectiveness of newer preservation techniques in extending ischemic tolerance.
• To analyze the cost-effectiveness and insurance coverage of different organ transport systems.

Main Methods:

• Review of existing literature and systems for hypothermic transport and machine perfusion.
• Analysis of studies demonstrating extended ischemic tolerance with newer preservation methods.
• Evaluation of cost per use and health insurance coverage for various organ transport technologies.

Main Results:

• Hypothermic transport remains the standard, offering good results within a limited ischemic time.
• Newer systems, including modified hypothermic transport (e.g., SherpaPak, Vitalpak) and machine perfusion (e.g., OCS, XVIVO), demonstrate extended ischemic tolerance.
• Significant cost differences exist, with standard hypothermic transport fully covered by insurance, while novel systems incur high costs (€10,000-€65,000 per use).

Conclusions:

• While newer organ transport technologies offer extended preservation, their high cost and limited insurance coverage in Germany restrict widespread adoption.
• The cost factor is a major barrier to implementing advanced heart preservation and transport systems.
• Further research and policy changes are needed to facilitate the broader use of innovative organ transport solutions.