Hypothermic Machine Perfusion in Deceased Donor Kidney Transplantation: Provider and Transplant Center Practices and Perspectives.

BACKGROUND: Hypothermic machine perfusion (HMP), an organ preservation technique used in deceased donor kidney transplantation, improves early outcomes compared to traditional static cold storage while also providing a loosely validated organ viability assessment. METHODS: We designed a survey to better understand the practices, perceptions, and barriers to utilization of HMP. Surgeons, nephrologists, and coordinators were invited to participate in the survey via email. RESULTS: Respondents (90% transplant surgeons) from 88 transplant centers which utilize HMP (35% of active kidney transplant centers) participated, representing 63% of total transplant volume in 2024. Respondents strongly agreed that HMP is helpful in kidney selection (92%), reduces delayed graft function (90%), and allows for scheduling flexibility (91%). A majority (74%) answered that the Organ Procurement Organization (OPO exclusively pumps kidneys. The most cited barrier to HMP use was OPO refusal (58%). Thresholds for resistance and flow varied widely with over 2/3 of respondents citing a specified acceptable cut-off. Most respondents answered "sometimes" (60%) or "yes" (20%) that they would decline a kidney if HMP could not be accomplished for a kidney they wished to be pumped. Perceived pitfalls were underutilization of kidneys due to incorrect or inaccurate perfusion parameters, logistical challenges and costs of pumping, inexperience and technical difficulties leading to organ or vasculature injury, and lack of standardization in practice. CONCLUSIONS: HMP is used as a tool to assess organ viability and to overcome logistical hurdles by improving flexibility in operative timing. OPOs play a critical role in the ability to perform HMP.