REVIEW article
Front. Transplant.
Sec. Organ and Tissue Preservation
Volume 4 - 2025 | doi: 10.3389/frtra.2025.1642724
This article is part of the Research TopicOrgan Transplantation by 2040View all 7 articles
The Hitchhikers Guide to Isolated Organ Perfusion: A Journey to 2040
Provisionally accepted
John Fallon*
Alex Sagar
Mohamed Elzawahry
Richard Dumbill
Hatem SadikKazuyuki Gyoten
Syed Hussain Abbas
Peter Friend- University of Oxford Nuffield Department of Surgical Sciences, Oxford, United Kingdom
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Building on the established success of hypothermic machine perfusion (HMP) and emerging normothermic platforms, machine perfusion is poised to guide a journey toward 2040, transforming organ transplantation into an era of integrated preservation, viability assessment, and ex situ therapy. While renal HMP today reduces delayed graft function and improves graft survival, the next two decades will centre on adaptive platform trials in normothermic perfusion, predictive AI-driven biomarkers, and unified registries to validate robust surrogate endpoints. Centralised Assessment and Reconditioning Centres (ARCs) will streamline 24/7 workflows, combining advanced imaging, molecular assays, and gene or cell therapies to repair and optimise grafts ex-vivo. Health economics will shift toward dynamic, value-based reimbursement, addressing equity and cost-effectiveness across diverse systems. Regulatory frameworks will adapt through CONSORT-style reporting and direct device-to-registry data integration, ensuring transparency and reproducibility. By 2040, these convergent advances in HMP, normothermic machine perfusion (NMP), along with translational research will not only enhance graft utilisation and patient outcomes but will redefine transplantation paradigms through precision graft management, optimised logistics, and new indications such as extracorporeal organ support.
Keywords: Controlled Oxygenated Rewarming COS; Core Outcome Set DCD, Donation after Circulatory Death DGF, Delayed Graft Function EAD, Early Allograft Dysfunction EVLP, Ex-Vivo Lung Perfusion HMP, Hypothermic Machine Perfusion HOPE, Hypothermic Oxygenated Machine Perfusion ICU, Intensive Care Unit IRI
Received: 07 Jun 2025; Accepted: 22 Jul 2025.
Copyright: © 2025 Fallon, Sagar, Elzawahry, Dumbill, Sadik, Gyoten, Abbas and Friend. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: John Fallon, University of Oxford Nuffield Department of Surgical Sciences, Oxford, United Kingdom
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