Heart allograft preservation: an arduous journey from the donor to the recipient

How are Organs Transported for Transplantation in Chile? An Exploratory Study

BACKGROUND

To determine how organs are transported and the safety of the process in Chile. Little is said in the medical literature about how to transport organs for transplantation. Is it safe?

METHODS

Exploratory study that characterizes the transport of organs in Chilean health centers in 2021. An interview was applied to selected groups, which were composed by expert health personnel in procurement and transplantation including nurses and surgeons. Seven semistructured interviews were conducted to deeply understand the organ packaging process, transportation, and advantages/disadvantages identified in these processes. Being an exploratory study, the sample was justified by the importance of the stories, details, and perceptions of each interviewee.

RESULTS

Seventy-one percent of the sample indicated that the organs are transported in polystyrene devices. One hundred percent of the respondents stated that to optimally preserve the organ, common ice is used. Eighty-six percent reported that "there is no record/monitoring of temperature," and 100% indicated that the quality of the receptacle does not keep the organ under the necessary care for its conservation and does not ensure, in the least, a safe transfer. The experts also indicated that according to figures from the Chilean Ministry of Health, in 2019, 5% of organs were not implanted due to transport problems, that is, 27 organs.

CONCLUSION

Chile needs modernization and professionalization in its organ transport procedures. It is necessary to raise standards, upgrade guidelines, and develop new technology in this area. In Chile, the way of transporting organs could be safer.

Peritransplant Cardiometabolic and Mitochondrial Function: The Missing Piece in Donor Heart Dysfunction and Graft Failure

Primary graft dysfunction is an important cause of morbidity and mortality after cardiac transplantation. Donor brain stem death (BSD) is a significant contributor to donor heart dysfunction and primary graft dysfunction. There remain substantial gaps in the mechanistic understanding of peritransplant cardiac dysfunction. One of these gaps is cardiac metabolism and metabolic function. The healthy heart is an "omnivore," capable of utilizing multiple sources of nutrients to fuel its enormous energetic demand. When this fails, metabolic inflexibility leads to myocardial dysfunction. Data have hinted at metabolic disturbance in the BSD donor and subsequent heart transplantation; however, there is limited evidence demonstrating specific metabolic or mitochondrial dysfunction. This review will examine the literature surrounding cardiometabolic and mitochondrial function in the BSD donor, organ preservation, and subsequent cardiac transplantation. A more comprehensive understanding of this subject may then help to identify important cardioprotective strategies to improve the number and quality of donor hearts.

Organ preservation solutions: linking pharmacology to survival for the donor organ pathway

PURPOSE OF REVIEW

To provide an understanding of the scientific principles, which underpinned the development of organ preservation solutions, and to bring into context new strategies and challenges for solution development against the background of changing preservation technologies and expanded criteria donor access.

RECENT FINDINGS

Improvements in organ preservation solutions continue to be made with new pharmacological approaches. New solutions have been developed for dynamic perfusion preservation and are now in clinical application. Principles defining organ preservation solution pharmacology are being applied for cold chain logistics in tissue engineering and regenerative medicine.

SUMMARY

Organ preservation solutions support the donor organ pathway. The solution compositions allow additives and pharmacological agents to be delivered direct to the target organ to mitigate preservation injury. Changing preservation strategies provide further challenges and opportunities to improve organ preservation solutions.

Complications of Cardiac Transplantation

PURPOSE OF REVIEW

Despite the improvement in medical therapy for heart failure and the advancements in mechanical circulatory support, heart transplantation (HT) still remains the best therapeutic option to improve survival and quality of life in patients with advanced heart failure. Nevertheless, HT recipients are exposed to the risk of several potential complications that may impair their outcomes. In this article, we aim to provide a practical and scholarly framework for clinicians approaching heart transplant medicine, as well as a concise update for the experienced readers on the most relevant post-HT complications.

RECENT FINDINGS

While recognizing that most of the treatments herein discussed are based more on experience than on solid scientific evidence, significant step forward has been made in particular in the recognition and management of primary graft dysfunction, antibody-mediated rejection, and renal dysfunction. Complications after HT may vary according to the time from surgery and can be related to graft function and pathology or to diseases and dysfunctions occurring in other organs or systems, mainly as side effects of immunosuppressive drugs and progression of pre-existing conditions. Future research needs to focus on improving precision diagnostics of causes of graft dysfunction and on reaching an optimal and customized balance between efficacy and toxicities of immunosuppressive strategies.