Ensuring access to novel donor heart preservation modalities.

Despite improvements in managing earlier stage heart disease, the population of patients needing heart transplants continues to increase in the United States. Fortunately, novel methods of procuring and preserving donor hearts, including the use of ex-vivo heart perfusion and controlled hypothermic preservation, have enabled a rise in heart transplantation. In particular, ex-vivo heart perfusion has contributed to increased utilization of donation after circulatory death (DCD), as well as enhanced use of donor hearts from increased geographic distances and extended criteria (marginal) donors. The use of such preservation technologies, however, has coincided with a significant increase in the cost of donor heart procurement and the advent of a donor organ procurement services industry. We aim to provide an overview on the rising costs of heart donation, explore the causes of such increase, and discuss potential solutions to drive both cost savings and increased access to heart transplantation.