The machine perfusion aim in organ transplantation is part of a broader effort to make donated organs easier to preserve and coordinate, according to a review in Frontiers in Transplantation. The authors argue that fragmented systems and implementation barriers compound donor scarcity, limiting how effectively available organs reach patients.
Rachana Yogesh Patil of Pimpri Chinchwad College of Engineering and Yogesh H. Patil of D. Y. Patil College of Engineering in Pune, India, reviewed research on artificial intelligence, blockchain, preservation and digital health. Their structured search covered five electronic databases. They screened 512 records and included 69 studies in a qualitative synthesis, focusing on work published from 2020 to 2026.
The review places those technologies against uneven transplant access. The Global Observatory on Donation and Transplantation reported 173,727 solid organ transplants across 92 countries in 2024. Kidney procedures made up 110,467 of them, roughly 64 percent, while liver procedures accounted for 42,497, or about 24 percent.
Machine Perfusion Aim Meets Uneven Systems
Regional rates also varied. The Americas recorded 69.96 transplants per million people and Europe 63.28. South-East Asia recorded 12.09, the Eastern Mediterranean 11.51 and Africa 1.35. The review describes Africa’s figure as a serious concern for access, infrastructure and resources.
Preservation is a practical part of that gap. Hearts and lungs have to be transplanted within a few hours, while kidneys can be preserved longer. Static cold storage remains the cheapest and most widely used method, but the authors say its limits are more apparent for marginal organs.
Hypothermic machine perfusion lowers metabolic demand while maintaining cellular integrity, and the review says it has proved useful for high-risk kidney and liver grafts. Normothermic machine perfusion restores near-physiological conditions, allowing real-time functional assessment and, in some cases, organ repair before transplantation. Sequential approaches combine hypothermic protection with normothermic evaluation.
Those methods are clinically more mature than several experimental approaches discussed in the paper. Supercooling preserves livers below zero without ice formation. Partial freezing enabled ten-day storage of rat livers in preclinical work. Vitrification with nanowarming aims at ice-free cryogenic preservation and rapid, uniform rewarming, but cryoprotectant toxicity and scalability remain obstacles.
Coordination Still Limits the Machine Perfusion Aim
Artificial intelligence could support donor-recipient matching, organ offer and discard predictions, post-transplant outcome estimates and allocation policy simulations. Some externally validated models outperformed traditional indices, while prototypes reported roughly 98 percent accuracy in kidney matching and about 10 percent improvement in kidney discard prediction. Other studies found machine learning performed similarly to regression-based methods. Most research remains retrospective, registry-based or single-center, without the prospective external validation needed to establish broader use.
The authors therefore frame AI as decision support that should augment clinician judgment. They identify algorithmic bias, data drift and interpretability as challenges. Blockchain could coordinate donor registration, waiting-list integrity, consent records, custody tracking and audits, but most applications remain at prototype or pilot stage. The review says blockchain cannot resolve organ scarcity, allocation fairness or clinical decisions by itself.
Digital monitoring also faces device reliability, security, network and hospital-system integration barriers. The authors call for interoperable data systems, standardized models, secure sharing, explainable and equitable AI, and preservation methods that are scalable and cost-effective. Their proposals also include capacity building and international cooperation to address infrastructure gaps between high-income and low- and middle-income regions.
The review’s conclusion is that combining technologies with clinical workflows, policy support and ethical governance matters more than any single tool. Its published review of the research sets out that integrated approach, while the authors emphasize the need for sustained international collaboration.
Related coverage examines hospital screening technology, another clinical technology deployment, and AI and blockchain infrastructure. Block Editorial has also covered blockchain infrastructure planning.
