Donor heart resuscitation and storage.

At the present time, simple hypothermia or regional or total body perfusion probably afford the best means of myocardial protection of the donor heart. However, the potential of either technique is extremely limited, and a combination of hypothermia with some form of perfusion system will probably enable considerably longer periods of storage of the donor organ. Such a perfusion system has not yet been conclusively developed, though considerable advances have been made. It is doubtful whether or not the addition of hyperbaric oxygen to hypothermia greatly prolongs the storage period. Metabolic inhibition by a chemical agent is an attractive method of preservation, possibly associated with hypothermia, but the search for the perfect agent continues. Actual freezing of the organ may prove feasible in the future, but recent work in the field of cryobiology has proved almost uniformly disappointing. The use of the autoperfusing heart-lung preparation as a short term storage system deserves further study, but its value as a really long term system of storage of the heart seems unlikely at the present time. Xenobanking has been encouragingly successful in experimental situations, but its clinical application will prove to be expensive and difficult.