Physiologic digital twins for decision support in multi-day ex vivo organ perfusion

Many potentially recoverable donor livers are discarded because current paradigms prioritize preservation and viability assessment over prolonged stabilization and rehabilitation. Multi-day normothermic ex vivo perfusion creates a therapeutic window but shifts the challenge from sustaining circulation to interpreting evolving physiologic trajectories without native homeostatic regulation. We propose physiologic digital twins that integrate mechanistic and statistical models to estimate organ state and support decision-making during ex vivo perfusion.