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To the Organ Transplantation Community,

As April unfolds, National Donate Life Month comes into focus, illuminating the urgent importance of organ, eye, and tissue donation. This dedicated month honors the incredible donors and their families whose selflessness transforms lives through organ transplants. An outcome of this awareness is the increased media attention on transplantation news. I urge your attention to a recent New York Times article (April 2, 2024; Ted Alcorn) that highlights this important issue. While it’s heartening to see mainstream media shed light on transplantation, there’s an equally important aspect of the story that warrants consideration alongside this commendable effort.

According to The New York Times, there’s a significant transformation underway in the field, primarily fueled by technologies enabling clinicians to temporarily preserve organs outside the body. Known as perfusion, this technique is revolutionizing every aspect of organ transplantation, from surgical procedures to donor eligibility criteria and recipient outcomes. Notably, transplant programs embracing perfusion are witnessing an increase in the number of organs transplanted. While this report highlights significant progress, it predominantly focuses on normothermic machine perfusion, potentially giving the impression that this alone represents the latest advancement in the field.

Normothermic machine perfusion is a method employed to maintain organs outside the body at normal body temperature (37°C). Despite certain benefits it offers over the conventional static cold storage method, it comes with a substantial price tag and demands significant resource allocation for upkeep. Consequently, many contend that its cost presents a major barrier to sustainable adoption.

However, the article’s assertion that blood is indispensable for maintaining organ viability doesn’t hold true when hypothermic oxygenated perfusion (HOPE) is employed. Through HOPE, organs are cooled to temperatures typically ranging between 4 and 10°C, significantly reducing their metabolic rate to about 10% of normal. Moreover, the system delivers oxygenated perfusion to the dormant organ while it awaits transplantation. Crucially, this oxygen-rich perfusion revitalizes the mitochondria, the powerhouse and energy reservoir of the cells. Essentially, this process primes the cells before transplantation, optimizing clinical outcomes and potentially mitigating the dreaded reperfusion injury that many transplant patients experience shortly after the life-saving surgery.

Although currently only available outside of the US, clinical data on hypothermic oxygenated perfusion (HOPE) is accumulating and, at least in these initial stages, indicates comparable or even superior outcomes compared to normothermic systems. While observing a hypothermic machine perfuse an organ may not hold the same visual appeal as witnessing a normothermic system in action, the true elegance of a HOPE system lies in its simple design. This simplicity translates into widespread acclaim for its ease of use, minimal monitoring needs, and more cost-effective pricing.

So, while I believe normothermic blood-based systems have their place, they do come with inherent tradeoffs. While they may attract attention of lay press, I contend that hypothermic systems provide a more sustainable and efficient option without disrupting existing clinical workflows. I believe exploring alternative methods for recharging mitochondria and mitigating reperfusion injury is crucial for the progression of organ perfusion technologies.

Stay tuned for further research milestones, as well my perspective on organ preservation news of relevance to us all.

Looking forward to seeing you in Madrid for ELITA Summit 2024 this month and at ILTS 2024 in Houston shortly thereafter.

Again, I welcome hearing from you regarding what would be valuable in these blog updates moving forward. You can reach out to me at BTLBlog@b2ll.com.

Don Webber
Chief Executive Officer
Bridge to Life Ltd.