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Updated: Jun 10, 2026
Innovative Strategies for Organ Preservation in Heart Transplantation: Uniform Cooling Preservation and Ex-situ Normothermic Perfusion
Published on: November 28, 2025
Alternative Preservation Strategies of Donation After Circulatory Death Hearts: Effect of Cold Ischemia Time Before
Manuela Lopera Higuita1, Emmanuella O Ajenu1, Maya Bolger-Chen1
1Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital Shriners Children's Boston Boston MA.
Insights
Controlled hypothermia followed by machine perfusion effectively preserves Donation after Circulatory Death (DCD) hearts. This method shows no significant difference in graft viability compared to immediate reperfusion, offering a promising alternative for expanding the donor pool.
Area of Science:
- Cardiovascular Surgery
- Organ Transplantation
- Ischemia-Reperfusion Injury
Background:
- Donation after Circulatory Death (DCD) heart transplantation can expand the donor pool by 20-30%.
- DCD hearts are susceptible to warm ischemia injury, necessitating reliable viability assessment.
- Current assessment methods have ethical, logistical, or resource limitations.
Purpose of the Study:
- To explore controlled hypothermia followed by normothermic machine perfusion as an alternative preservation strategy for DCD hearts.
- To evaluate graft viability using a novel ex vivo cardiac loading method.
- To compare outcomes with immediate reperfusion after procurement.
Main Methods:
- Porcine DCD hearts underwent 19 minutes of warm ischemia.
- Hearts were preserved using static hypothermic storage (4-8°C) for up to 7 hours.
- Graft viability was assessed via normothermic machine perfusion and ex vivo cardiac loading.
Main Results:
- No significant functional differences were observed between hypothermia-preserved and immediately reperfused DCD hearts.
- Biochemical and proteomic analyses showed no significant differences.
- Controlled hypothermia preservation up to 7 hours maintained graft viability.
Conclusions:
- Controlled hypothermia offers a viable alternative to current DCD heart preservation methods.
- This approach avoids ethical concerns and reduces logistical complexity and costs.
- Findings support a shift towards more effective and cost-efficient DCD heart preservation.
Background:
Donation after circulatory death (DCD) offers a promising strategy to expand the donor pool by 20% to 30%. However, DCD heart grafts experience warm ischemia injury, making effective graft viability assessment before transplantation prudent. Current methods for assessing DCD hearts are impacted by either ethical concerns and regional limitations (thoracoabdominal normothermic regional perfusion) or the need for significant resources, expertise, and equipment, with limitations in functional assessment (direct procurement and reperfusion, via the Organ Care System by TransMedics). This study explores an alternative preservation approach using controlled hypothermia followed by normothermic machine perfusion for graft evaluation.
Methods:
DCD grafts were procured from porcine donors after 19 minutes of functional warm ischemia. Hearts were preserved using controlled hypothermic static storage at 4 °C to 8 °C for up to 7 hours, followed by reanimation with normothermic machine perfusion. Graft viability was evaluated using a novel ex vivo cardiac loading method. Outcomes were compared with DCD grafts reperfused immediately after procurement.
Results:
No significant functional, biochemical, or proteomic differences were observed between DCD cardiac grafts preserved via controlled hypothermia for up to 7 hours and those reperfused immediately after procurement.
Conclusions:
Controlled hypothermia may be a viable alternative to current DCD preservation methods, eliminating ethical concerns of thoracoabdominal normothermic regional perfusion and reducing logistical complexity and costs associated with direct procurement and reperfusion. These findings provide a foundation for a potential shift in DCD heart preservation practices, offering a more effective and cost-efficient approach to expand the donor pool and improve transplantation outcomes.
