Donor Heart Preservation

Cooling reduces the heart’s cellular metabolic activity during the interval between recovery and transplantation. By slowing these energy-demanding processes, cold storage helps limit injury caused by inadequate oxygen delivery, known as ischemic injury. The preservation solution provides the surrounding medium for this cooled state, helping maintain myocardial structure and function until the heart can be implanted.

Ex vivo perfusion circulates fluid containing oxygen and nutrients through the donor heart rather than relying only on cooling to slow metabolism. This support can maintain the organ in a beating or metabolically active state under controlled conditions. The approach is important because it may preserve myocardial viability while giving the transplant team an opportunity to evaluate function.

Static cold storage primarily protects the heart by reducing cellular activity through cooling, whereas ex vivo perfusion supports the organ with circulating oxygenated, nutrient-containing fluid. The two strategies therefore address preservation differently: one suppresses metabolic demand, while the other supplies controlled support to an active or metabolically maintained heart. This distinction influences how teams preserve and assess donor organs.

Ischemic injury can threaten myocardial viability during the period between organ recovery and implantation. Preservation methods seek to reduce that damage so the donated heart retains usable structure and function. Maintaining viability is clinically relevant because the heart must tolerate transport and the transplantation procedure, particularly when recovery, travel, or circulatory stress creates a longer or more challenging preservation interval.

The heart is recovered from the donor, placed into a selected preservation system, and maintained until it reaches the recipient hospital. With static cold storage, cooling and preservation solution are used; with ex vivo perfusion, controlled circulation of oxygenated, nutrient-containing fluid supports the organ. Before implantation, the transplant team can use the preservation period to assess the heart’s function.

Ex vivo perfusion may be particularly useful when the heart must travel a longer distance or has experienced circulatory stress. Its controlled circulation can support a beating or metabolically active organ and provide information about performance before implantation. This added support and assessment may help teams evaluate hearts that require more than the protection offered by conventional static cold storage.

Better preservation can extend the practical distance between donor and recipient hospitals by helping maintain the heart during transport. It may also increase the number of donor hearts considered usable, especially when organs face longer travel or circulatory stress. In this way, preservation advances can enlarge the donor pool while supporting safer decision-making before transplantation.

Because ex vivo systems maintain the heart under controlled perfusion conditions, they can allow transplant teams to assess organ function before implantation. This evaluation complements preservation itself: the system both supports myocardial viability and supplies information about how the heart performs outside the donor and recipient bodies. Such information can contribute to safer heart-transplantation decisions.