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Transplantation is the therapy of choice in end-stage organ failure. The increasing need for transplants, combined with the decreasing number of donors, creates the necessity of broadening the donor inclusion criteria and optimizing the organ preservation procedure to avoid early and late graft dysfunction. This review aims to provide a summarized overview of the available preservation solutions and their development, the pathophysiology of ischemia/reperfusion injury, and underline the necessity and the future directions in the field of organ preservation.