Embargoed until 10:30 AM EST, Sunday, 27 April, 2025
Donor Hearts Are Now Traveling Unprecedented Distances Thanks to Machine Perfusion Technology
Pioneering Advances Could Herald a New Era of International Heart Transplants
In a groundbreaking advancement for cardiac transplantation, donor hearts are now being transported over considerably longer distances due to enhancements in machine perfusion technology. This breakthrough is particularly transformative for countries such as Australia, where the vast geographic expanse poses immense logistical challenges to heart transplantation. Previously, the substantial distances between major cities like Perth and Sydney – nearly 2,000 miles apart – made it nearly impossible to transport donor hearts within the window of viability, leading to many potentially life-saving organs going unused.
At this year’s Annual Meeting and Scientific Sessions of the International Society of Heart and Lung Transplantation (ISHLT) held in Boston, Dr. Emily Granger, a leading cardiothoracic and transplant surgeon at St. Vincent’s Hospital in Sydney, detailed how her team has been at the forefront of extending the viability of donor hearts during transport. The conventional method of using portable ice-filled coolers has long limited heart preservation to about six hours, a window that severely restricts the geographic reach of donor organs.
The advent of machine perfusion has revolutionized this scenario by keeping donor hearts metabolically active during transit. This technology involves a sophisticated device that continuously pumps a blood-analog solution through the coronary arteries of the excised heart, maintaining it at near-physiological temperatures and providing oxygen and nutrients essential for cellular metabolism. By preserving myocardial function in this normothermic state, the device effectively reduces ischemic injury during transport.
Since adopting this technology in 2014, St. Vincent’s Hospital has progressively expanded the use of normothermic machine perfusion (NMP) for donor hearts obtained after circulatory death (DCD). Currently, over half of the center’s heart transplants utilize machine perfusion, a testament to its clinical efficacy and growing acceptance. The capability to maintain hearts in a viable state for up to eight hours—and in some Australian centers, even ten hours—has dramatically increased the reach of transplant programs.
The implications of this technological leap are profound. Dr. Granger emphasized that this innovation has effectively “removed time from the equation,” enabling transplant teams to confidently accept organs from regions previously deemed logistically impossible. The ability to extend the viable preservation time means donor hearts can now be procured from distant locales, reducing geographic disparities in organ availability and ultimately saving more lives.
Looking to the future, the prospect of an international network for heart exchange is becoming increasingly tangible. Australia’s current collaboration with New Zealand for organ retrieval is just the beginning; extended perfusion times may soon facilitate organ retrieval from even more geographically remote regions such as the Pacific Islands and parts of Asia. This would represent a monumental shift in global transplantation logistics, potentially enabling patients to receive organs from genetically diverse populations—a critical factor for recipients who face difficulties finding suitable local donors.
Research data emerging from St. Vincent’s has demonstrated that outcomes using machine perfusion are on par with those from traditional cold storage methods. Studies specifically assessing primary graft function post-transplantation reveal no significant differences, suggesting that the technology not only prolongs transport time but does so without compromising the delicate function of the donor heart. This insight is particularly critical in alleviating concerns regarding prolonged ischemic times and associated graft failure.
The physiological rationale underlying these results lies in the continuous delivery of oxygenated blood-like perfusate and metabolic substrates during transport, preventing the onset of hypoxic injury that is typical with static cold storage. Moreover, the normothermic environment preserves the heart’s metabolic machinery in a state conducive to repair and recovery, potentially reducing reperfusion injury upon transplantation.
This technology marks a paradigm shift in heart transplantation. Dr. Granger reflected on the dramatic evolution she has witnessed over her career—from reliance on basic ice-packed coolers to state-of-the-art machine perfusion systems that push the boundaries of what is possible. The transformative potential of machine perfusion is evidenced not only in extended preservation times but also in fostering innovative strategies for organ allocation, equity, and accessibility on an unprecedented scale.
While current technological capabilities have extended transport times significantly, ongoing research and engineering efforts are poised to enhance this even further. Future iterations of machine perfusion may refine perfusate compositions, optimize temperature and pressure parameters, and integrate real-time functional assessments of the donor heart during transit. These advancements could usher in a new era where the concept of “organ transport time” becomes virtually obsolete.
In summary, the integration of normothermic machine perfusion into clinical practice is setting the stage for a global transformation in heart transplantation. By mitigating ischemic damage and extending preservation windows, this technology is erasing traditional geographic constraints and bringing hope to patients worldwide who previously might not have had access to suitable donor hearts. As Dr. Granger succinctly noted, the only current limitation is the imagination of transplant teams in harnessing these new capabilities to their full potential.
Subject of Research: Machine Perfusion Technology in Heart Transplantation and Its Impact on Donor Heart Preservation and Transport
Article Title: Donor Hearts Are Traveling Longer Distances with Machine Perfusion: A Transformative Leap Toward International Heart Exchange
News Publication Date: 27 April 2025
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Keywords: Perfusion, Organ donation, Transplantation, Lungs, Heart
