The development of cold perfusion boxes revolutionized organ transplantation by significantly extending the viability of donor organs. Introduced in the 1960s, these devices were designed to provide hypothermic preservation, reducing metabolic activity and ischemic injury in transplanted organs. Early efforts in organ preservation relied on static cold storage using ice and preservation solutions such as Euro-Collins or University of Wisconsin (UW) solution. However, these methods were limited in maintaining organ quality, particularly for extended periods or marginal donor organs. Cold perfusion boxes emerged as a dynamic alternative, combining continuous perfusion of preservation solutions with hypothermic temperatures (4°C). These devices ensure oxygenation, nutrient delivery, and waste removal during ex vivo preservation, mimicking physiological conditions in a slowed metabolic state. Initial designs were focused on renal transplantation, with kidneys being perfused extracorporeally using pulsatile pumps to mimic natural blood flow. Studies demonstrated improved graft function, reduced delayed graft function (DGF), and extended preservation times compared to static storage. Modern cold perfusion technologies have evolved to include multi-organ preservation systems capable of supporting livers, hearts, and lungs. These advancements have facilitated the use of expanded criteria donor organs, improved transplant outcomes, and increased the donor organ pool. The history of cold perfusion boxes exemplifies the intersection of engineering and medicine in advancing organ transplantation science.