Heart allograft preservation: an arduous journey from the donor to the recipient.

Abstract

The discrepancy between needs and availability of organs for heart transplantation may be partially reduced by improving the utilization of organs currently deemed unsuitable. Strategies to achieve this goal need optimization of the entire process of organ procurement, transportation, and functional recovery after transplant. In the latest years, several studies reported improvements in organ utilization after appropriate donor management, and management of heart transportation is approaching a new era. In particular, apart from perfecting of traditional cold static preservation techniques, novel technologies now allow continuous heart perfusion prolonging out-of-body times, and prompted to the 'resuscitation' of hearts injured by the warm ischemia of circulatory death donors. The accomplishment of the journey needs appropriate protection of the graft during and after the transplant surgery. This concept is driven by adequate donor-recipient matching and aided by the assist devices that, mimicking organ perfusion machines, may allow graft reconditioning while maintaining recipient's peripheral organ function. The researches reviewed in this article support a significant improvement of the heart preservation during the multifaceted process of procurement, transport, and transplant. Future challenges will be to develop healing of currently unsuitable organs, while keeping the cost of technology within the borders of affordability for healthcare systems.