AUTHOR=Fischer Konrad , Denner Joachim , Tönjes Ralf Reinhard , Felgendreff Philipp , Rahmel Axel 
  
TITLE=Logistics of clinical xenotransplantation: from donor pig production to global organ distribution
  
JOURNAL=Transplant International
  
VOLUME=Volume 39 - 2026
  
YEAR=2026
  
URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2026.17326
  
DOI=10.3389/ti.2026.17326
  
ISSN=1432-2277
  
ABSTRACT=The shortage of transplantable organs remains one of the most significant unmet challenges in modern medicine. Despite advances in donor management, organ preservation, surgical techniques, and immunosuppression, organ demand continues to exceed supply worldwide. Xenotransplantation using genetically engineered porcine organs has emerged as a promising strategy to address this gap. Recent clinical pig-to-human heart and kidney transplantations have demonstrated the feasibility of clinical xenotransplantation and shifted attention from immunological barriers toward practical implementation. This review examines the logistical requirements for clinical xenotransplantation, with particular emphasis on donor herd management, biosafety, organ preservation technologies, and future distribution networks. The integration of donor production with advanced machine perfusion technologies may ultimately transform transplantation medicine from a donor-dependent emergency service into a predictable and scalable therapeutic platform.