Alexis Carrel, the French surgeon born in Lyon in 1873, pioneered vascular anastomosis and organ transplantation, for which he was awarded the Nobel Prize in Medicine in 1912. Carrel had a long-time dream of permitting an entire organ to live outside the body for an indefinite time. He realized that to make this true, he needed a pump to perfuse the organ under physiological conditions, forcing oxygen into a continuously circulating fluid. In 1920, he moved to the Rockefeller Institute in New York, where he worked with the great aviator Charles Lindbergh, the first to fly across the Atlantic, as his mechanical alter ego. Together, they devised a perfusion pump that was the forerunner of modern pump oxygenators, as promisingly depicted on the cover of Time in June 1938. 1 Carrel and Lindbergh worked on keeping whole hearts, kidneys, and other organs alive artificially with nutrient perfusion fluids under culture conditions, that is, at normothermia. Hence, with their concept of whole-organ perfusion, their ultimate goal was to immortalize organs by pulsing serum containing nutrients and growth factors through the organ enclosed in an incubator, almost exactly as in life. Now, 70 years later, we have come as far as being able to preserve organs with sustained function ex vivo over 1 night or, in the case of the liver, even less, which is only a minute fraction of the liver's in vivo lifespan.
This issue of Liver Transplantation features an article by Vairetti et al. 2 showing that fatty livers are more susceptible to preservation injury than normal livers and that this type of injury can be reduced by machine perfusion (MP) preservation as opposed to static, cold storage. Liver damage was even further diminished by