Development and Validation of an Ultra-low-cost, Open-source Normothermic Ex Vivo Organ Perfusion Platform

Background. Normothermic machine perfusion (NMP) promises to catalyze organ preservation, therapeutic discovery, and disease modeling. Commercial organ perfusion devices remain inaccessible for research because of restricted access, high costs, and steep technical learning curves. Methods. To overcome these barriers, an NMP circuit was developed using recycled, repurposed, and low-cost components. Porcine kidneys and autologous blood were used for iterative optimization. A porcine kidney autotransplantation protocol was adapted to evaluate in vivo kidney function after NMP. Nontransplantable human donor kidney, spleen, and pancreas specimens were perfused using human blood products. Results. This effort resulted in an ultra-low-cost (~$2000) NMP system capable of perfusing porcine kidneys and human organs (kidney, pancreas, and spleen) for up to 24 h with evidence of both function and viability. Key innovations included a mechanism to permit low-flow perfusion in nonheparinized organs and a containment bag with adjustable magnets to provide stabilization. Porcine kidneys perfused on this platform demonstrated in vivo function upon autotransplantation with survival for 30 d. Conclusions. We conclude that an ultra-low-cost NMP platform can be constructed from readily available materials. This financially sustainable and scalable model provides a road map to advance ex vivo discovery.