*Purpose: During the first shipments of human organs by drone, we identified significant differences in pressure and vibration that may adversely affect shipped organs. Liver transplants moved by aircraft have worse 1 year mortality rates than organs moved by ground. Further, 40 percent of primary non-function (PNF) amongst kidney transplants have no identifiable cause. Whereas donor and recipient organ function are monitored minute-to-minute, shipped organs are not monitored or tracked.

*Methods: An animal model of MHC disparate heart transplantation was developed. Organ vibration during traditional flight was modeled using a tabletop vortex shaker to study the impact on transplant outcome. Hearts were exposed to vibration prior to transplantation.

*Results: We previously reported on the first human transplant of kidney flown 2.8 miles by UAS, and we compared UAS with fixed-wing flight during which UAS demonstrated less vibration by more than 1.5G. Modeling shipment, fully MHC mismatched cardiac transplants were performed in mice. Vibrated hearts failed in 12 vs more than 45 days for controls (p=0.01). Vibrated hearts showed increased Annexin V+ (apoptosis) in the epicardium (3 fold) and myocardium (8-fold; p=0.01). TUNEL-positive cells increased within vibrated hearts 10-fold (p=0.01), suggesting increased cell death.

*Conclusions: There is an unmet need to learn what environmental factors during shipment affect organ integrity. Understanding how organs are affected by the environment would allow for innovative solutions for shipment safety, organ allocation, and selection of mode of organ transportation.

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