Donor heart preservation and perfusion

Due to its technically simple and easily reproducible nature cold static preservation is still the current gold standard for myocardial protection in between donor explantation and recipient implantation. It allows “safe” overall ischemic periods of up to 4 hours with a primary graft failure rate less than 2%. Additional measures such as second rinsing or leucocyte depleted in-situ reperfusion allow to extend the ischemic tolerance in ideal donor hearts to 6 hours. Recent technological progress and research improved results of continuous warm, blood based in-vitro perfusion reducing the necessity of myocardial ischemia to the surgical procedures of ex- and implantation. First clinical experiences with this challenging but also very expensive technology indicate its safety and efficacy with at least similar results as cold static preservation even with extended transport times. Due to possible donor evaluation or even resuscitation strategies during ex-vivo perfusion, it offers furthermore promising potential to compensate the ever increasing donor risk profile and could also help to increase availability of transplantable donor hearts. As of December 2011 a German multicenter prospective registry study will start with the goal to evaluate efficacy and outcome of this method in 250 heart transplants using donor organs with extended criteria or expected transport times of >3 hours. Expected duration of this project is 2 years and final analyses of collected data will help to clarify if application of this complex and expensive technology is ultimately beneficial and justified.