New Perfusion- and Preservation Strategies for Donor Hearts

Currently, there are several different systems and methods available for organ procurement and transportation in the context of heart transplantation. The hypothermic transport of the cardioplegic heart is certainly the most widely used method. Ultimately, this approach has been the global standard since the 1980s and the introduction of the brain death definition, i.e., the largely controlled heart procurement. The results of this procurement and transportation technique are very good and have been reproducible for decades. However, it should be emphasized that with this technique, there is still a critical limit for the organ's ischemic time of around 4-5 hours. The newer preservation and transport techniques are primarily characterized by their ability to extend ischemic tolerance. This has now been demonstrated in studies for all systems used. However, it is important to differentiate between hypothermic transport with current modifications (e.g., SherpaPak, Vitalpak) and so-called machine perfusion (e.g., OCS, XVIVO). A relevant criterion for selecting the appropriate system is undoubtedly the cost per use, as well as, particularly in Germany, the coverage by health insurance companies. While the currently standard technique of hypothermic transport in a Styrofoam box after cardioplegia is fully covered by insurance, the significantly higher costs of other systems are, to date, only covered within the framework of studies or must be covered by the users themselves. Currently, this issue (costs ranging from €10,000 to €65,000 per use, depending on the system) represents a significant limitation for the further and widespread adoption of these novel devices.