Ex vivo heart perfusion for increasing organ availability

Background. Heart transplantation still remains the gold standard for patients with end-stage heart failure. Due to the lack of donor organs the use of ex vivo heart perfusion is becoming increasingly more important for reconditioning marginal donor organs. Objective. New developments in the field of ex vivo heart perfusion are presented with an emphasis on the practical application in a donor organ retrieval service. Material andmethods. The utilization of the Organ Care System (OCS, TransMedics, Andover, MA) for evaluation and reconditioning of marginal donor organs is discussed in the light of the substantial shortage of donor organs. Results. Preservation using the OCS can be considered as being equivalent to cold cardioplegia in the clinical application. An OCS heart shows a highly significant reduction in the cold ischemia time so that longer transport times and subsequently greater catchment areas are possible. Extended criteria donors can be conditioned to be suitable donor organs by the professional application of the OCS. Resuscitation of socalled donation after cardiac death (DCD) donor hearts using OCS has been clinically established internationally and the results are very promising. Conclusion. We postulate the standardized application of ex vivo heart perfusion for marginal donor organs to extend the potential donor pool.