Optimising Organ Donation: Lowering Body Temperature Before Transplantation
Lowering the body temperature of donors in the intensive care unit before retrieving organs may not improve how soon a transplanted organ starts working, according to a systematic review published up to September 2025. Solid organ transplantation remains the optimal treatment for end-stage organ failure, yet clinicians continually face a shortage of viable organs. Many donor grafts originate from patients who have experienced brain death in intensive care units, a pathophysiological state known to induce severe cellular injury in target organs. Researchers evaluated whether therapeutic hypothermia in donors could preserve graft quality, but the latest clinical data reveals no significant functional advantage for recipients.
Key Clinical Takeaways:
- Cooling deceased donors below normal core temperatures (below 35.5 degrees Celsius) may not shorten the time it takes for transplanted kidneys, livers, or lungs to begin functioning.
- The intervention maintains a high safety profile, showing no evidence of increasing donor cardiac complications or reducing the total pool of available organs.
- Current clinical evidence is largely limited to kidney transplants, with a distinct lack of 12-month quality-of-life data or long-term organ-specific functional metrics.
Evaluating the Clinical Impact on Kidney Grafts
Solid organ transplantation involves transferring a healthy kidney, heart, liver, lung, or pancreas from a donor to a recipient suffering from terminal organ failure. Because brain death triggers an overwhelming systemic inflammatory cascade and hemodynamic instability, optimizing donor management is critical to graft survival. Investigators analyzed four international studies encompassing 2,096 donors to see if reducing core body temperatures via external cooling systems, ice packs, bladder irrigation, or temperature-controlled ventilation gases could mitigate this ischemic damage. Across four studies involving 3,015 recipients, lowering donor temperature may not reduce the time required for transplanted kidneys to achieve primary function. Furthermore, data from three studies tracking 2,075 participants indicated that donor cooling may make no statistically significant difference to graft survival at one year post-transplant. A single study evaluating 526 kidney recipients similarly found no survival benefit for patients at the one-year milestone.
Outcomes Across Livers, Lungs, and Donor Safety
Beyond renal outcomes, clinical trials tracked the physiological response of other solid organs subjected to donor temperature management. Data from a study of 99 lung transplant recipients showed that therapeutic cooling may not accelerate graft function onset. Similarly, an analysis of 262 liver transplant recipients found no reduction in delayed graft function times when donors were cooled prior to organ retrieval. Reassuringly, the intervention did not compromise the broader transplant supply chain. Across four trials involving 4,265 participants, lowering donor temperature was shown to be unlikely to reduce the total volume of organs available for clinical use. Assessment of donor safety across three studies comprising 2,015 individuals confirmed that cooling protocols may not trigger adverse cardiac events or other systemic complications in the donor prior to retrieval.
Methodological Limitations in Current Transplant Research
Despite the robust scale of the combined patient cohorts, the underlying evidence base carries notable clinical limitations. One-year survival data for the transplanted organs appeared in only three of the reviewed studies. Furthermore, vital downstream metrics—including recipient quality-of-life indices at 12 months, post-transplant heart disease incidence, cardiac ejection fraction, and a pancreatic recipient’s ongoing need for exogenous insulin—were entirely absent from the published literature. The medical literature remains heavily skewed toward kidney donors, leaving a notable evidence gap regarding the optimization of extra-renal organs.