COPE

Consortium on Organ Preservation in Europe

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 Obiettivo del progetto (Objective)

'The discrepancy between organ supply and demand remains the biggest challenge facing the transplant community today. In order to increase the amount of available donor organs, transplant specialists are increasingly turning to sub-optimal donor organs. Organs from such donors, usually have normal or near normal function before death, but retrieval, storage and transplantation cause progressive injury to the organ. Injury is predominantly caused by inadequate or absent delivery of oxygen and nutrients, either in the warm or cold preservation environment. New techniques to improve organ preservation are being developed and the COPE consortium including: • Normothermic liver machine perfusion (NMP) • Hypothermic kidney machine perfusion (HMP) • Novel additives for preservation solutions These strategies are all directed to the vital period that starts at the time of circulatory arrest and extends to the point of transplantation. Specifically, they will tackle the following challenges: • Exposure of donor organs to ischaemic injury whilst the organs remain in the donor. • Progressive deterioration of the organ during conventional organ preservation. • Repair of the organ during preservation using perfusate and pharmacological interventions. • Identification of reliable predictors of organ viability using biological and other pre-transplant parameters. The COPE consortium is the official organ preservation task force of ESOT and consists of a number of European transplantation centers, front running transplantation research groups and a number of SMEs involved in developing perfusion fluids and technology. Together, they will be able to generate the statistical power and protocols necessary to test, validate and promote these new organ preservation techniques and increase the number of available solid donor organs.'

Introduzione (Teaser)

The availability of donor organs is exceedingly low in comparison to the demand for them. To increase utilisation of all transplantable organs, the transplant community is in urgent need of better preservation techniques.

Descrizione progetto (Article)

Suboptimal organs have near-normal function but progressive injury usually occurs during retrieval, storage and transplantation. This is mostly due to lack of nutrients and oxygen in the preservation environment. Moreover, such organs are more susceptible to preservation injury as the donors are usually older patients with other co-morbidities such as diabetes and hypertension.

Techniques like normothermic liver machine perfusion (NMP), hypothermic kidney machine perfusion and novel additives for preservation solutions show promise for improving organ preservation. The EU-funded 'Consortium for Organ Preservation in Europe' (http://www.cope-eu.org (COPE)) project will test, validate and promote these novel organ preservation techniques to increase availability of viable organs for transplant.

The COPE consortium is the official organ preservation task force of the European Society for Organ Transplantation (ESOT). They will carry out three clinical trials and additional experimental studies to test kidney and liver preservation techniques and develop optimal protocols.

Significant milestones have already been achieved. The necessary set-up for managing and running clinical trials has been put into place and ethical approvals obtained at most of the trial sites. The clinical trial protocols were finalised, and online and offline databases as well as centralised biospecimen collection protocols were established for each trial. Logistics regarding transportation, organ retrieval, and machines and consumables were also attended to. For instance, the OrganOx metra device required for NMP has been installed in ambulances in the United Kingdom.

All COPE clinical trials have now begun. Scientists are assessing the efficacy of cell-free perfusion media in liver and kidney transplantation as well as ex vivo metabolic reconditioning of organs. They are also evaluating the pros and cons of optimisation of pre-implantation conditioning of organs and the effects of different temperature settings on perfusion.

Project outcomes should help reveal the feasibility of these innovative machine perfusion technologies and cell-free oxygen carrying systems for improving organ preservation. Positive trial results will increase availability of good-quality organs for transplant and improve outcomes for patients on the transplant waiting list.