Improving organ preservation by developing a new cold storage solution is a goal of many investigators. Currently, a common approach is to make minor changes in the UW solution and make a claim for an improved and different preservation. It may be difficult to dramatically improve organ preservation by simple cold storage and we may have reached the limits of safe storage (about 24 to 48 hours). The reason for this conclusion is based upon the organ's need for a source of energy to prevent tissue destruction. Energy must be constantly brought into the thermodynamically unstable tissues and cells; otherwise, membranes, cytoskeletal networks, cell-cell interactions, and various complex molecular structures break down. In cold ischemic storage there is no currently known method to maintain a satisfactory energetic state without continuous perfusion with perfu-sate or oxygen. The use of machine perfusion may be the method that could improve organ preservation. Improving the quality and longevity of heart preserva tion certainly may require continuous perfusion. In the heart, the lack of ATP leads to ischemic contracture due to the high concentration of contractile proteins. This ischemic contracture destroys the viability of the tissue. The liver can tolerate machine perfusion for 3 days and the kidney for 5 to 7 days. However, the arguments against using machine perfusion in a clinical setting are formidable. First, one-year graft survival in kidneys machine perfused or cold stored are about equal (about 90%). Second, machine perfusion is more expensive and requires a trained perfusionist. Third, most kidneys are now shared between centers that require some form of simple cold storage for shipment. Thus, without a clearly convincing rationale for machine perfusion, cold storage with short preservation times will probably continue to be used for most organs.
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