Machine perfusion for donor organ repair: From vision to everyday clinical practice

The worldwide shortage of suitable donor organs for transplantation has led to a renewed interest in techniques that can facilitate the safe transplantation or suboptimal donor organs. Suboptimal donor organs such as, for example, those from older donors and donation after circulatory determined death donors may still be used for successful transplantation if they can be protected against ischemia-reperfusion (IR) induced injury during ex situ organ preservation. Dynamic organ preservation such as ex situ machine perfusion is a rapidly evolving technique that can protect donor organs against IR injury. In liver transplantation, both ex situ hypothermic oxygenated machine perfusion and normothermic machine perfusion have already entered into clinical practice. The technology may potentially be developed further and applied to repair injured organs to improve their quality. This chapter provides an overview of the current insights and application of machine perfusion technologies in liver transplantation.