Reviewing the TransMedics Organ Care System as a Modality for Increasing Donor Organ Viability

Heart disease continues to prevail as the leading cause of death in the United States and worldwide. Transplantation is currently the standard of care for treating many cases of end-stage heart disease, but a shortage of donor hearts has made it difficult to provide transplantation to all patients who may benefit from it. One limitation that causes increased discard of potentially viable organs is the brief time for which an organ is viable. The most common current storage method is static cold storage, which permits up to 4 hours of safe storage time. A newer technology, TransMedics Organ Care System (OCS), permits longer storage time via ex vivo perfusion, simulating physiological conditions, and allows a live functional assessment of the heart. Several clinical trials have evaluated the transplant success and survival rates, along with rates of adverse effects, of the OCS, with the system showing noninferiority to static cold storage in both metrics, while allowing for increased safe storage time. This makes the system particularly useful for organs donated after brain death, an application for which the system was approved for use in 2021. OCS applications for lung and liver transplantation have also been investigated, with similar benefits being observed in the transplantation of these organs. OCS provides a means to vastly increase the donor pool at no expense to organ viability and address the donor organ shortage in healthcare.