Revitalizing donor organs: The potential of mitochondrial transplantation in heart and lung transplantation

Heart and lung transplantation remain the primary treatments for end-stage organ failure; yet organ shortages and ischemia-reperfusion injury (IRI) limit their success. Extended criteria donors (ECDs) have expanded the donor pool; however, prolonged cold ischemia times increase the risk of primary graft dysfunction (PGD). Static cold storage (SCS), the standard organ preservation method, is suboptimal, leading to mitochondrial dysfunction, ATP depletion, and oxidative stress. Recent advancements in organ storage show promise in maintaining graft viability. Mitochondria are key regulators of cellular homeostasis, and their dysfunction exacerbates IRI, contributing to inflammation and graft failure. Mitochondrial transplantation (MTx) has emerged as a novel therapeutic strategy to restore cellular bioenergetics, reduce oxidative stress, and improve graft function. Further research is needed to optimize MTx protocols and integrate them into current preservation techniques to enhance transplant success and long-term graft survival.