Extended criteria donors are increasingly frequent in times of persisting organ shortage. Many of these organs are prone to pronounced ischemia reperfusion injury (IRI). Generally, IRI remains an inherent and unavoidable event in solid organ transplantation and its full extent becomes only apparent after transplantation. So far, graft assessment prior to transplantation is mainly based on calculated donor risk scores, subjective evaluation by an experienced transplant surgeon and histopathological assessment of biopsies.

Due to organ shortage and increasing waitlist mortality, critical evaluation of extended criteria donor organs is compulsory. Nevertheless, prevention of DGF and primary non-function of an allograft remains crucial for graft and recipient survival. In a pilot study of 17 deceased donor kidney transplants, intraoperative HSI assessment predicted DGF and timely intervention could be guaranteed. Objectives of our studies are the validation of the initial data sets, the assessment of other solid organ grafts, the evaluation of threshold values, and graft assessment during machine perfusion.