Innovative technology preserves and assesses livers, hearts, and lungs from donors following brain death (DBD) and after circulatory death (DCD).

The TransMedics (Andover, MA, USA) Organ Care System (OCS) is designed to maintain donor organs in near physiologic and functioning state outside of the human body, from the time the organ is removed from the donor, and until it is ready to be transplanted into a suitable recipient. The system works by perfusing the organ with warm oxygenated blood to minimize cold ischemia injury; optimizing the organ by replenishing oxygen, nutrients, and hormones that would otherwise become depleted; and providing continuous monitoring and assessment of the organ until the point of transplantation.

The system consists of a console, a reusable, portable enclosure that houses an electronic display and the non-sterile mechanical and electrical elements required to warm, pump, and ventilate the organ; a perfusion module, with an organ chamber and circulatory system to perfuse the organ; and a high oncotic solution for ex-vivo flushing and perfusion of the organ, when combined with packed red blood cells (pRBCs). The technology can increase the pool of current donor organs, improve patient survival, and reduce post-transplant complications.

“I am convinced that broad availability of warm extracoporeal donor liver perfusion will be the most important advance for the field of liver transplantation in decades,” said James Markmann, MD, chief of the division of transplantation surgery at Massachusetts General Hospital (Boston, USA). “OCS Liver has the potential to save many lives by making liver transplants safer and by expanding the pool of available liver allografts.”

The cornerstone of organ preservation has long been cold ischemic storage. Although this method is intended to reduce the extent of organ damage during transport, significant deterioration of the donated organ still occurs; the longer the organ is kept on ice, the greater the damage. Moreover, the cold storage technique does not enable any resuscitative or assessment while the organ is being transported from donor to recipient. It is estimated that 60-65% of organs cannot ultimately be used for transplantation due to the limitations of cold storage. 

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