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New heart preservation methods expand who can donate and how far organs can travel

New heart preservation methods expand who can donate and how far organs can travel

New Capabilities

Vanderbilt's REUP technique triples preservation time at a fraction of current costs, potentially transforming heart transplantation

February 13th, 2026: Aaron Williams named to TIME100 Health list

Overview

For decades, a donated heart had to reach its recipient within four hours, and only hearts from brain-dead donors qualified. Both constraints are now falling. A Vanderbilt University team has published results in the Journal of the American Medical Association showing that their REUP technique—a flush of oxygenated blood, del Nido cardioplegia solution, and cardioprotective additives—can preserve a heart from a donor whose heart has stopped beating for up to eight hours, with outcomes matching or exceeding existing methods at roughly $2,000 per transplant instead of $65,000.

About 3,800 Americans currently wait for a donor heart, and 13 people die each day waiting for an organ of any kind. The new technique works on hearts from donation after circulatory death donors—people who die when their heart stops rather than from brain death—a pool that existing methods have only recently begun to tap. By eliminating the need for expensive perfusion machines and sidestepping the ethical controversies surrounding techniques that restart circulation in a deceased donor's body, REUP could make heart transplantation accessible to more patients and more hospitals.

Why it matters

Every hour added to heart preservation time means thousands more potential donors and recipients can be matched across greater distances.

Play on this story Voices Debate Predict

Key Indicators

~$2,000
REUP cost per transplant
Compared to roughly $65,000 for TransMedics Organ Care System perfusion devices
8 hours
Maximum preservation time demonstrated
Traditional cold storage limits hearts to about four hours outside the body
95.8%
30-day recipient survival
Among 24 patients who received REUP-preserved hearts between November 2024 and July 2025
3,800
Americans on the heart transplant waiting list
Demand for donor hearts consistently exceeds supply
0
Hearts discarded
None of the 24 hearts recovered using REUP were discarded before transplant

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People Involved

Aaron Williams
Aaron Williams
Named to TIME100 Health list of influential leaders in 2026
 Ashish Shah
Ashish Shah
Leads one of the nation's highest-volume heart transplant programs

Organizations Involved

Vanderbilt University Medical Center
Vanderbilt University Medical Center
Academic Medical Center
Developed and tested the REUP technique

Vanderbilt's heart transplant program ranks second in the United States by volume and has become a leading center for developing alternatives to expensive perfusion-based organ recovery.
TransMedics
TransMedics
Medical Device Company
Manufacturer of the only FDA-approved ex situ heart perfusion system

TransMedics makes the Organ Care System, which keeps donor hearts beating and warm during transport—the current standard for donation after circulatory death heart transplants, but at roughly $65,000 per use.

Timeline

  1. Aaron Williams named to TIME100 Health list

    Recognition

    TIME recognized Williams as a "pioneer" on its 2026 list of the 100 most influential people in health for his work developing the REUP technique.

  2. REUP results published in JAMA

    Research

    The Journal of the American Medical Association published Vanderbilt's study of 24 REUP heart transplants showing 95.8% 30-day survival, zero discarded hearts, and preservation times up to eight hours—all at roughly $2,000 per transplant.

  3. Related storage study shows reduced graft dysfunction

    Research

    Vanderbilt published findings on a new donor organ storage method that reduces rates of severe primary graft dysfunction, complementing the REUP work.

  4. Preliminary REUP results announced

    Research

    Vanderbilt announced early results from the REUP technique showing hearts preserved for up to eight hours with outcomes comparable to existing methods.

  5. Vanderbilt performs first REUP heart transplant

    Milestone

    Vanderbilt's cardiac surgery team performed the first transplant using their REUP flush technique, avoiding both machine perfusion and normothermic regional perfusion.

  6. Federal scrutiny of normothermic regional perfusion intensifies

    Policy

    The Health Resources and Services Administration received a letter raising patient safety and ethical concerns about normothermic regional perfusion, prompting the Organ Procurement and Transplantation Network to develop new guidelines.

  7. DCD hearts reach 11% of U.S. heart transplants

    Data

    The share of heart transplants using donation after circulatory death donors grew from 2% in late 2019 to 11%, driven by the spread of perfusion technology.

  8. First modern DCD heart transplant in the United States

    Milestone

    Duke University surgeons performed the first donation after circulatory death heart transplant in the U.S., opening a new donor pool that had previously been off-limits for hearts.

  9. United Kingdom publishes first major DCD heart transplant results

    Research

    Royal Papworth Hospital published results from 50 patients receiving hearts from circulatory death donors, showing 100% 30-day survival matching traditional brain-death donations.

  10. First human heart transplant performed

    Milestone

    Christiaan Barnard performed the first human heart transplant in Cape Town, South Africa, using a heart from a circulatory death donor—the original form of heart donation before brain death criteria became standard.

Scenarios

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1

REUP adopted widely, DCD heart transplants double within three years

If multi-center trials confirm Vanderbilt's single-center results, REUP's dramatically lower cost and logistical simplicity could make DCD heart transplantation feasible at hospitals that cannot afford the TransMedics Organ Care System. The technique requires no specialized perfusion device, meaning community transplant programs could begin recovering DCD hearts. This would expand both the number of centers performing these transplants and the geographic reach of each recovered heart.

Discussed by: Vanderbilt researchers and transplant surgery commentators noting the cost and simplicity advantages
Consensus —
2

Larger trials reveal limitations, REUP becomes niche complement to machine perfusion

Twenty-four patients is a small cohort. Multi-center replication could show that REUP works well for straightforward cases but that machine perfusion remains necessary for marginal donor hearts, longer transport distances, or when real-time organ assessment is critical. In this scenario, REUP would serve as a cost-effective option for nearby, healthy donors while the TransMedics system handles complex cases.

Discussed by: Transplant medicine skeptics and medical device analysts noting the small sample size of 24 patients
Consensus —
3

Regulatory and ethical shifts favor REUP over normothermic regional perfusion

Normothermic regional perfusion, which restarts blood flow through a deceased donor's body, faces unresolved ethical objections about whether it violates the dead donor rule. If regulators restrict or add significant requirements to NRP, REUP offers a ready alternative that avoids reanimating circulation entirely. Programs currently using NRP could switch to REUP without major infrastructure investment, accelerating adoption.

Discussed by: Bioethicists and the Organ Procurement and Transplantation Network amid ongoing NRP policy debates
Consensus —
4

Preservation window extends to 12+ hours, enabling national organ sharing

If the preservation window reliably reaches 12 hours, as some preliminary reports from Williams suggest, geography largely ceases to constrain heart transplant matching. A heart recovered in Nashville could reach any transplant center in the continental United States. This would fundamentally change organ allocation policy, reducing the advantage that patients near major trauma centers currently have and enabling better immunological matching across the entire waiting list.

Discussed by: Vanderbilt's own team, which has reported preservation up to 12 hours in some accounts, and organ allocation policy analysts
Consensus —

Historical Context

First human heart transplant and the shift to brain death donors (1967-1968)

December 1967 - 1968

What Happened

Christiaan Barnard transplanted the first human heart in Cape Town using a heart from a donor whose heart had stopped—a circulatory death donor, in modern terminology. But the patient, Louis Washkansky, died 18 days later. As brain death criteria were formalized in 1968 by a Harvard committee, the field shifted almost entirely to brain-dead donors, whose hearts could be kept beating on ventilators until recovery.

Outcome

Short Term

Brain-dead donors became the standard, offering hearts that never stopped beating and could be preserved on ice for about four hours.

Long Term

For over 50 years, only brain-dead donors were considered for heart donation, excluding a large pool of potential donors who died by cardiac arrest.

Why It's Relevant Today

The REUP technique returns to the original concept—recovering hearts that have stopped beating—but with modern preservation science that Barnard lacked, potentially reopening a donor category that was abandoned for half a century.

Organ Care System and the machine perfusion revolution (2011-2021)

2011 - 2021

What Happened

TransMedics developed the Organ Care System, a portable device that keeps a donor heart warm and beating during transport. After years of clinical trials, it received Food and Drug Administration approval in 2021. The technology enabled the modern resurgence of DCD heart transplantation in the United States by allowing surgeons to assess whether a stopped heart was viable before committing to transplant.

Outcome

Short Term

DCD heart transplants became possible in the U.S., growing from zero to 11% of all heart transplants by 2023.

Long Term

The $65,000-per-use cost and operational complexity limited adoption to large, well-funded transplant centers, creating a two-tier system.

Why It's Relevant Today

REUP achieves a similar outcome—viable DCD heart transplants—without the machine, at roughly 3% of the cost. If validated, it could democratize what the Organ Care System made possible only for elite centers.

Laparoscopic surgery displaces open surgery (1987-2000s)

1987 - 2000s

What Happened

When Philippe Mouret performed the first laparoscopic cholecystectomy in 1987, skeptics questioned whether minimally invasive surgery could match open techniques. Within a decade, laparoscopic gallbladder removal became the default. The pattern—a simpler, cheaper technique initially dismissed by advocates of expensive, complex alternatives—repeated across surgical specialties.

Outcome

Short Term

Early adopters faced skepticism and calls for larger trials before widespread adoption.

Long Term

The simpler technique won because it reduced costs, recovery times, and barriers to entry for smaller hospitals.

Why It's Relevant Today

REUP faces the same dynamic: a simpler approach challenging an established, expensive technology. History suggests that if outcomes hold up in larger studies, cost and simplicity advantages tend to drive adoption even against institutional inertia.

Sources

(10)
+4
Vanderbilt University Medical Center News Human Progress Interesting Engineering TCTMD Duke Department of Surgery Health Resources and Services Administration organdonor.gov (U.S. Department of Health and Human Services) Vanderbilt University Medical Center News Vanderbilt University Medical Center News Vanderbilt University Medical Center News