Machine Perfusion in an Ageing Population - Results From a German, National Survey Among Transplant Centers.

Machine perfusion (MP) is rapidly emerging as an alternative to static cold storage in transplantation, providing notable benefits in graft preservation and repair. To better understand the current landscape of machine perfusion in Germany, we conducted a survey among all 39 liver and kidney transplant centers. A total of 22 centers (56%) responded, with 63% (14/22) reporting to have an active MP program. Liver transplantation programs utilize both hypothermic and normothermic perfusion, whereas perfusion strategies in kidney transplantation remain largely limited to hypothermic techniques. Most liver centers (57%; 8/14) apply MP selectively to marginal grafts. 43% (6/14) use it routinely for all accepted organs. Respondents reported an average 10% increase in organ utilization rates attributed to MP. While the clinical benefits of MP are widely acknowledged, key challenges persist, particularly regarding limited funding and insufficient clinical- and research infrastructure. The existing MP programs were predominantly financed through internal funding and only 33% (5/15) had a dedicated perfusion team. Current research in MP focus on viability assessment, objective graft evaluation criteria, organ repair, and strategies to expand the donor pool. Despite promising outcomes and increasing adoption, Germany needs a clear funding framework to fully integrate MP into routine clinical practice.