Organ retrieval and preservation

Organ transplantation relies on the retrieval, assessment and preservation of donor organs before implantation. Organs may be obtained from living or deceased donors, presenting different surgical, physiological and logistical considerations. Retrieval surgery aims to minimize warm ischaemia and avoid iatrogenic graft injury. Living donor retrieval, particularly relevant for kidney donation, prioritizes donor safety and is now usually performed using minimally invasive techniques. Deceased donor retrieval occurs as a coordinated multi-organ procedure involving abdominal and cardiothoracic teams. Successful implantation also relies on graft preservation, which has traditionally relied on static cold storage, utilizing hypothermia and specialized preservation solutions used to flush the graft at the point of retrieval to reduce cellular metabolism and limit ischaemic injury. However, cold storage does not fully prevent cellular damage, and machine perfusion strategies are increasingly used to improve organ assessment and utilisation. Hypothermic machine perfusion is established for kidney preservation and has growing evidence in liver transplantation, while normothermic regional perfusion and ex situ normothermic machine perfusion are expanding the use of donation after circulatory death and marginal organs. Ex situ organ perfusion to enable delivery of therapeutics is the subject of ongoing research efforts to further optimize graft success. Advances in retrieval and preservation are central to improving transplant outcomes and safely increasing the donor organ pool.