The cold chain supply of donor organs for transplantation has been an integral part of the delivery of transplant clinical services over the past five decades. Within the technologies used for this, hypothermic machine perfusion (HMP) was a concept, which was attractive to maintain organs under optimal conditions outside the body, and many early research studies on HMP were reported. However, it took the arrival of important new concepts to ensure that HMP was logistically feasible and valuable from an organ physiology perspective within the clinical pathways. This review provides details of the current status of HMP across the range of organs transplanted in the clinic, and discusses what new areas might benefit from applying HMP in coming years. In conclusion, HMP is now being used more frequently for clinical organ preservation in a variety of settings. As new therapies such as cell or gene therapy become more common, HMP will continue to play an important facilitator role for optimising organs in the donor pathway
