Enhanced recovery of disqualified donor organs using image-guided machine perfusion

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DESCRIPTION (provided by applicant): In the United States alone, 76,000 lives are claimed by liver disease every year. Transplantation is currently the only established treatment, but there is a critical shortage of donor organs. More than 60% of candidates wait over a year to receive a transplant, the majority becoming too ill to tolerate the procedure. These numbers could be improved dramatically by expanding the available donor pool through the rescue of disqualified donor organs; conservatively estimated at 6,000 livers per year. We and others have shown experimentally that machine perfusion, an artificial body and blood supply for isolated donor organs, is a powerful methodology capable of administering treatment and significantly increasing viability. However, unlike tightly-controlled experimental livers, there is a large degre of variability that characterizes human donor organs, from a range of pre-existing comorbidities to the circumstances of death and the duration of warm and cold ischemia experienced during procurement and transportation. There is currently no way to objectively assess the status and therefore likelihood of recovery of individual organs, which also prevents the development of organ-specific treatment regimens to be administered during machine perfusion. Machine perfusion is therefore currently being conducted blindly, inhibiting its true clinical potential an vertical advancement of the field. Our long-term goal is to minimize deaths due to organ shortages by engineering robust strategies to enhance the availability of whole organ- and cell-based therapies. The objective of the proposed study is to validate an innovative imaging approach for qualitative and quantitative evaluation of donor organs at the time of procurement and during perfusion. The work described here is expected to produce novel metrics of organ viability enabling accurate diagnosis of ischemia and real-time evaluation of organ recovery. Future consequences of this work will be its expansion to other systemic disease states, guidance of real-time, organ- specific interventions during perfusion, and the prediction of time to optimal recovery. These developments will facilitate the clinical translation of machine perfusion as a dynamic preservation system for all donor organs.