From ice to innovation: the evolution of heart preservation methods

Heart failure (HF) remains a growing global public health crisis. Despite medical advances aimed at improving longevity and quality of life, heart transplantation remains the gold-standard treatment for individuals with end-stage heart failure (ESHF). With an ageing population and increasing ESHF prevalence, the need for donor organs continues to grow rapidly. The introduction of machine perfusion (MP) has played a pivotal role in increasing the heart transplantation donor pool. Unlike static cold storage (SCS) traditionally used to transport organs, MP has been shown to decrease ischaemia reperfusion injury (IRI), allow for ex-situ donor organ assessment and extend preservation times thereby minimising procurement logistical barriers such as long-distance travel. Additionally, MP has facilitated the implementation of donation after circulatory death (DCD) pathway which has increased donor pools by up to 25%. In this review, advances in the field of machine perfusion as a means of graft preservation will be summarised with a focus on current technologies such as hypothermic and normothermic machine perfusion. Outcomes of current technologies will be summarised, limitations with standard practice will be analysed, and the future direction of graft preservation research discussed.