Research and innovation in the deceased donor.

Advances in solid organ transplantation have transcended the expectations of the pioneering clinicians who initiated these endeavors for patients with end-stage organ disease. Beginning with renal transplantation and evolving to other organs, we have witnessed a steady increase in transplantation as an effective therapy for end-stage organ failure. Unfortunately deceased donation has stagnated over the past several years even as the number ofwaitlisted patients continues to increase. While most advances in clinical transplantation have been recipient-centric, future growth in transplantation will likely come from donor-focused innovations that increase the number and viability of organs donated for transplantation. Despite this pressing clinical need, clinical science surrounding donor management or ex vivo organ interventions remains in its infancy. The landscape of deceased donor research studies is dominated by low-risk studies that have involved different preservation solutions or static versus perfusion storage for kidneys. A limited number of studies have evaluated hormonal therapy, fluid resuscitation or ischemic preconditioning strategies (1–3). The veritable paucity of high quality, prospective randomized controlled trials in brain dead deceased donors is in part due to the significant regulatory and logistical challenges to performing transformative research in donation and transplantation (4). The lack of scientific research has hampered evidence-based progress for the field.