The Future of Donor Heart Preservation

In recent years, the field of donor heart preservation has rapidly expanded to incorporate several new technologies aimed at increasing the available donor pool. Traditional ice cold storage, although effective, allows for limited preservation time and also subjects the organ to cold-induced injury. Controlled hypothermia systems improve temperature stability and reduce cold injury, while normothermic ex vivo perfusion platforms enable continuous metabolic support while also incorporating functional assessment, allowing for the utilization of extended-criteria and donation after circulatory death donors. Hypothermic oxygenated perfusion represents a hybrid approach combining the benefit of hypothermia with continuous oxygen delivery, allowing for enhanced preservation and extended preservation times. Emerging techniques such as rapid recovery and intermediate-temperature (10°C) storage further aim to enhance myocardial protection while offering to reduce costs and logistical complexities. Altogether, these technologies represent various strategies that have the potential to expand donor utilization, improve graft preservation, and increase access to heart transplantation.