Organ reconditioning and machine perfusion in transplantation

Society’s self-sufficiency in terms of organ replacement is still far away from being achieved, given the large disparity between transplant demand and donor organ availability. In the attempt to reduce this discrepancy and expand the donor pool, the transplant community has progressively increased the utilisation of extended-criteria donors (ECD) such as older donors, donors with comorbidities and donation after circulatory death (DCD). The main challenge preventing a wider utilisation of ECD and DCD allografts is the higher susceptibility to the ischemia-reperfusion injury (IRI) (1), an unavoidable part of the transplantation process. For this reason, in the last decades, there has been an exponential development on organ reconditioning strategies, in order to enable graft resuscitation and viability assessment prior to implantation (2).