Expert Perspectives on a Randomized Controlled Trial Comparing Novel Donor Storage Platforms to Cold-static Preservation for Heart Transplantation.

Background: There is a clinical need for randomized evidence to establish the comparative efficacy of organ preservation techniques for heart transplantation in Canada. In this study we used a survey to evaluate the feasibility and value of a randomized trial comparing cold-static preservation with novel donor storage platforms. Methods: A validated survey was distributed to 30 members of the Canadian Cardiac Transplant Network, including adult heart failure cardiologists, pediatric cardiologists, and cardiovascular surgeons. Survey sections addressed demographics, clinical scenarios, perceived benefits, barriers, and willingness to participate in a randomized trial. Results: Twenty-six experts (87%) responded: 65% were adult heart failure cardiologists, 27% were women, and 54% practiced in Ontario. Respondents were evenly distributed across career stages. All expressed interest in participating in a trial, and 88% were comfortable with study blinding. Willingness to randomize declined with anticipated ischemic times: > 80% for < 6 hours, 42% for 6-8 hours, and 31% for > 8 hours. Key benefits identified included improved donor utilization (69%), better outcomes (58%), and enhanced scientific understanding (58%). The major barrier was device cost (73%). Conclusions: Canadian experts reported interest and perceived equipoise for a randomized trial of organ preservation strategies, although cost remains a key barrier. Such a trial could standardize protocols and strengthen the evidence base guiding heart transplantation practice.