Transcontinental heart transplant using SherpaPak cold static storage system

Organ preservation in heart transplantation is key to preventing primary graft dysfunction, the most common cause of early graft loss. Historically, the standard of care was preservation on ice, with no monitoring ability and problems with even temperature distribution. Recently, the SherpaPak, an Food & Drug Administration-approved transport device, has emerged as a solution to these 2 issues, allowing for even temperature distribution, no organ contact with ice, and continuous monitoring during transport. This method of transport falls under static cold preservation, but may allow for longer ischemic times beyond the recommended 4-hour limit. Here, we report a case of heart transplantation using the SherpaPak transport device for a distance of almost 3000 miles and total ischemic time over 7 hours—the longest yet reported for a donor heart transported using the SherpaPak system. The patient had excellent functional outcomes with no evidence of primary graft dysfunction. This case suggests that, with careful donor and recipient selection, SherpaPak may potentially be used for longer distances and ischemic times than initially recommended, as a safe and cheaper alternative to ex-vivo perfusion devices.