Abstract
The use of expanded criteria donor (ECD) and donation after circulatory death (DCD) donor is one of important way of resolution for the critical shortage of diseased donor graft. However, the ischemic damage of these grafts jeopardizes organ viability during cold storage. Simple cold storage is the most widely used form of preservation in clinical practice even for these marginal grafts. However, it is questionable whether this method is able to prevent from deterioration of ECD or DCD organ quality. Although, the fact that hypothermic machine perfusion might be superior to static cold preservation in reducing the high incident of delayed graft function, marginal grafts are exposed to warm and additional hypothermia induced damage. This review describes current concepts and development of machine perfusion preservation for marginal graft. The beneficial effects of normothermic machine perfusion as a new perspective preservation for DCD grafts also are introduced. The development of novel preservation technology and science to recover from severe ischemic damage must be improved in marginal donor era.
