Myocardial preservation in heart transplantation.

The current techniques of donor procurement and transplantation provide a very low incidence "of non rejection graft failure", following cardiac transplantation. Attention needs to be paid to the preservation of organ function in the potential donor, in order to maximise the donor availability in an environment of perpetual donor shortage. The strategies aimed at myocardial preservation in the donor will be methods of protection from the pathophysiological changes associated with onset of cerebral injury and brain death. The role of various types of cardioplegia, additives and preservation fluids need to be investigated to minimise the effects of cardiac ischaemia and reperfusion injury. There is evidence to suggest the improvement in long term survival with tissue matching in cardiac transplantation. This will need methods of prolonging safe ischaemic time for the donor heart so that tissue matching and organ sharing can be carried out.