In the latest instalment of The Lancet's series of articles on organ donation, the high-calibre scientific team discusses ways of more accurately assessing transplant suitability and actively improving the quality of donor organs. The focus is on new technical procedures such as perfusion, in which organs removed from the body are perfused with a special fluid to test, maintain or even improve their function. "A large proportion of donated organs are not transplanted today due to concerns about their quality – in the USA alone, around 50,000 potentially transplantable organs are discarded every year," says study co-author Andreas Zuckermann from the Department of Cardiac and Thoracic Aortic Surgery at MedUni Vienna. "However, recent studies suggest that with appropriate interventions, many of these organs could be successfully transplanted."
Perfusion as a decisive advance in transplant medicine
In addition to imaging techniques and biochemical parameters, functional tests and histological analyses are increasingly being used to assess organ function prior to transplantation. Perfusion also allows the organ's metabolism to be monitored and specifically influenced. This makes it possible, for example, to reduce inflammatory reactions, render existing viral infections harmless or change the blood group. "These developments show that we are becoming increasingly capable of not only assessing organs, but also actively improving them," says Andreas Zuckermann, commenting on the advances in transplant medicine. Xenotransplantation (transplantation of animal organs) is also being discussed as a possible future solution – in particular the use of genetically modified pig organs, which are already being tested in initial clinical studies.
Modern organ transplantation began with the successful kidney transplant between identical twins in 1954. Since then, advances in surgery, immunology and intensive care medicine have helped make transplants an established treatment for many seriously ill patients. Nevertheless, the shortage of donor organs remains a key challenge – while at the same time, donated organs are often not used. In Europe, this affects 21 percent of donated kidneys and 58 percent of hearts, for example. Medical strategies to increase the number of organs that can actually be transplanted and reduce waiting times for patients are only part of the solution: "The challenge lies not only in medical feasibility, but also in ethical, organisational and health policy frameworks," says Zuckermann, whose participation in the international expert committee underlines the globally recognised importance of MedUni Vienna in the field of transplant medicine.
Publication: The Lancet
Scientific advances in the assessment, modification, and generation of transplantable organs for patients with end-stage organ diseases.
Ciara M Shaver, Peter P Reese, Adam Griesemer, Andreas Zuckermann, Matthew Bacchetta
https://doi.org/10.1016/S0140-6736(25)00239-9