Systems engineering the organ preservation process for transplantation.

• Static cold storage is a key bottleneck for all regenerative medicine therapies. • Machine perfusion is an important emerging organ preservation technology. • Subzero preservation holds the promise to enable organ banking. • Machine perfusion and subzero preservation can be used in synergy. Improving organ preservation and extending the preservation time would have game-changing effects on the current practice of organ transplantation. Machine perfusion has emerged as an improved preservation technology to expand the donor pool, assess graft viability and ensure adequate graft function. However, its efficacy in extending the preservation time is limited. Subzero organ preservation does hold the promise to significantly extend the preservation time and recent advances in cryobiology bring it closer to clinical translation. In this review, we aim to broaden the perspective in the field from a focus on these individual technologies to that of a systems engineering. This would enable the creation of a preservation process that integrates the benefits of machine perfusion with those of subzero preservation, with the ultimate goal to provide on demand availability of donor organs through organ banking. [ABSTRACT FROM AUTHOR]