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[Comment] Donor heart preservation: straight up, or on the rocks?

Donor heart preservation using cold static storage is associated with ischaemic injury that restricts the safe preservation interval, contributes to the low utilisation rate of available donor organs, and significantly affects post-transplant survival.1,2 The pioneering work of Oscar Langendorff,3 in 1895, led to the realisation that an excised heart could be reanimated and maintained in a beating state with isolated perfusion.4 Subsequent research has sought to refine the technique of ex-vivo heart perfusion to minimise ischaemic injury, extend the safe preservation interval, optimise organ allocation, resuscitate dysfunctional hearts, and enable viability assessments before transplantation.