Advances in organ preservation for transplantation

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The field of organ transplantation continues to push the boundaries between the possible and impossible, allowing successful function in grafts that would previously have been deemed non‐viable. Such advances have been necessitated by the continuing gap between organ supply and demand, despite overall increases in transplantation rates.
In particular, we have seen a significant shift towards the utilization of organs from donation after circulatory death (DCD) and expanded criteria (ECD) donors, as compared with standard criteria donation after brain death (DBD) donors. These organs theoretically have a higher chance of short‐term and/or longer‐term dysfunction, owing to an increased duration of warm ischaemic insult and/or suboptimal pre‐donation function due to higher donor age and comorbidities.
A major contributing factor to the expansion of the donor pool has been the modification and enhancement of the organ preservation process post‐procurement. Not only have there been advancements in preservation solution(s) used, but we have also seen a significant shift away from the traditional paradigm of static cold (hypothermic) organ storage (CS). In fact currently, there is a worldwide push towards dynamic organ storage, such as the use of machine perfusion (MP), potentially in association with perfusate oxygenation and normothermia.
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