Inflation in preservation? A retrospective study of preservation fluid use during organ procurement
Axel Andersson, Ulrika Samuelsson, Helena TaflinAbstract
Introduction
During procurement, the aorta is flushed with preservation solution (PS) to reduce oxidative stress, minimize cellular edema, and maintain metabolic and acid–base balance. Although international guidelines recommend 4000 ml for abdominal organ procurement, actual volumes are often determined intraoperatively. This study examines trends in PS use during organ procurement and evaluates whether administered volumes have increased over time.
Methods
A retrospective analysis was conducted on 219 adult organ procurements identified through the YASWA organ allocation system, including cases from 2019, 2022, and 2025. Continuous variables were analyzed using independent-samples t-tests. Subgroup analyses compared abdominal-only procurements with combined thoracic and abdominal procedures, as well as donation after circulatory death (DCD) versus donation after brain death (DBD).
Results
PS volumes ranged from 3000 to 7000 ml. Four donors received 3000 ml, 78 received 4000 ml, 99 received 5000 ml, 29 received 6000 ml, and eight received 7000 ml. Mean PS volume increased over time, from 4259 ml in 2019 (n = 57) to 4623 ml in 2022 (n = 77) and 5329 ml in 2025 (n = 85). Procurements involving thoracic organs were associated with higher abdominal flush volumes compared with abdominal-only procedures (4958 versus 4718 ml; P = 0.04). DCD donors received significantly higher volumes than DBD donors (5333 versus 4698 ml; P < 0.001).
Discussion
PS volumes increased between 2019 and 2025 and frequently exceeded current guideline recommendations. The rationale for this increase remains unclear, suggesting a need for a more standardized approach to PS administration to improve resource utilization.