Sept. 15, 2026
With an ongoing global shortage of transplantable livers, transplant surgeons must continue to rely on higher risk grafts from organs that might not otherwise be considered for transplant. However, current approaches to viability assessment lack the sensitivity and specificity to reliably distinguish suitable grafts from those at risk. This can lead both to usable organs not being transplanted and to the acceptance of grafts that subsequently develop complications.
Now, a real-time monitoring system, a collaboration between Mayo Clinic and the Terasaki Institute for Biomedical Innovation, is changing the approach to organ evaluation ahead of liver transplantation and laying the groundwork for advances in organ preservation.
Michelle C. Nguyen, M.D., a transplant surgeon at Mayo Clinic in Arizona, is part of the research team deploying a novel biochemical monitoring platform that offers a more complete picture of a donor liver's health during machine perfusion.
The challenge of liver shortages and the need for better evaluation
Medically complex or high-risk liver grafts from extended-criteria donors and donation-after-circulatory-death donors have expanded organ availability for patients who need livers urgently. Still, these organs come with higher risks, such as early allograft dysfunction, nonanastomotic biliary strictures, and primary nonfunction, among other complications.
"By giving transplant teams a clearer understanding of an organ's health, we're working toward a future where more donated livers can safely reach the patients who need them most."
Because of these challenges, transplant surgeons need an accurate and reliable assessment of organ viability before deciding whether to move forward with the donor liver.
Historically, surgeons assessed a donor organ's suitability largely through the donor's clinical history and gross evaluation of the liver, often supplemented by biopsy. Machine perfusion has changed that paradigm. By connecting the donor liver to a device that pumps oxygen-rich fluid throughout the organ, the technology keeps the liver alive and functioning outside the body.
This process affords transplant teams the time to assess the liver's viability directly through perfusion parameters and biochemical markers that indicate whether the organ is functioning. Among the most important of these are metabolic markers such as lactate, which is typically monitored through blood samples collected manually every 30 to 60 minutes.
"While these samples do a good job of reflecting the health of the hepatocytes, they aren't perfect," Dr. Nguyen says. "They give an incomplete picture of the entire organ, particularly the health of the bile ducts, which is a major determinant of transplant success. Intermittent sampling can show us a trend over time, and with a marker like lactate, it's really the trend of clearance that tells us an organ is recovering more than any single number. But sampling every 30 to 60 minutes can miss what happens in between. Continuous, real-time monitoring gives us that trend in much finer detail, so we can see how an organ is responding as it happens and catch meaningful changes earlier."
Evaluating and treating organs in real time
Recognizing biochemical changes in organ health in real time gives the transplant team a chance to intervene early, before permanent organ damage occurs, which is a goal made possible through machine perfusion.
"Machine perfusion is opening the door to a future where we don't just evaluate organs, we treat them and even improve them before transplant," Dr. Nguyen says. "But to get there, we first need better ways to understand how an organ is performing in real time. That's what this technology is built to provide."
To meet the need for real-time monitoring and treatment, Dr. Nguyen and her team developed a wireless sensor platform for autonomous, continuous monitoring. This platform helps transplant teams track glucose, lactate and pH in both the perfusion fluid and bile in real time, overcoming the challenges of intermittent sampling and delivering better information to inform transplant decisions.
In a study published in Nature Communications, the measurements from the sensor aligned with the standard laboratory testing. The sensor also detected biochemical changes between sampling intervals that may have otherwise been missed.
"Every organ donated is incredibly valuable," Dr. Nguyen says. "By giving transplant teams a clearer understanding of an organ's health, we're working toward a future where more donated livers can safely reach the patients who need them most."
A more comprehensive pretransplant assessment for more organs
As a follow-up to this study, Dr. Nguyen and her team are working toward a more comprehensive assessment panel, including expanding the platform to identify additional markers of organ health. Given the success with liver transplant, they also are looking for opportunities to adapt this technology for kidney, heart and lung transplants.
"While we need more research to expand both clinical validation and technological versatility of the platform, this study establishes a clinically deployable architecture for biochemical monitoring," Dr. Nguyen says. "It offers initial evidence for the feasibility of data-driven, viability-associated assessment before liver transplantation."
For more information
Zhou K, et al. A clinically deployed dual-compartment biochemical monitoring platform for human liver perfusion. Nature Communications. 2026;17:5627.
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