Strategies for Liver, Heart, and Lung Viability Assessment While Using Donor In-Situ or Ex-Situ Advanced Perfusion

Advanced machine perfusion technologies such as in-situ normothermic regional perfusion (NRP) and ex-situ normothermic (NMP) and hypothermic machine perfusion (HMP) are being rapidly adopted in the field of transplantation as an alternative to traditional static cold storage (SCS).

Advanced perfusion aims to reverse organ injury suffered during the procurement process, minimize further organ injury during storage and increase tolerable overall storage time. Despite all these advantages, one of the greatest benefits of advanced perfusion may be the ability to assess organ viability and thus avoid harmful recipient events after transplantation, provided the viability cutoff is respected. To be useful in the assessment of viability, a marker should be able to provide enough confidence to accept an organ for transplantation without being so strict as to lead to non-utilization of a high number of organs. In addition, for real-time decision making, viability markers also need to be rapid and widely available.

Advanced perfusion will continue to become more widely adopted in the field of organ transplantation. Viability assessment will be a crucial component of safely expanding the donor pool with organs that were historically considered “marginal”. The current manuscript provides an overview of the state of viability testing in liver, heart, and lung assessment, however it is clear that further research into viability markers is needed.