Background Ex-vivo perfusion is an emerging technique with that involves the maintenance of tissue in a metabolically active state outside of the body, which represents a paradigm shift from traditional preservation methods such as static cold storage by replicating physiological conditions to support cellular metabolism rather than downregulating and suppressing it. However, the high metabolic oxygen demand of normothermic tissue has required the specific development of effective oxygen carriers. Historically limited to whole blood, this has been associated with issues related to haemolysis and microvascular thrombosis – recent development of proprietary haemoglobin-based oxygen carriers (HBOCs) provides a promising alternative that circumvents these issues. This rapid progress has resulted in a broad, heterogenous body of literature with a without clear consensus on ideal perfusate composition. Method A literature review was conducted, identifying 42 articles comprising a total of 694 specimens. A technical study was performed in-vitro to assess performance of packed red blood cell (pRBC) perfusates – comparing human pRBC-crystalloid, pRBC-plasma and whole blood compositions. Metrics included oxygen-carrying capacity, biochemical markers, thromboplastic characteristics and cell aggregation. Results 29 studies used cellular perfusate and 24 used acellular solutions. Of these, 40 used biological-based and 13 used synthetic perfusate. In vitro study of the comparison fluids yielded superior performance of the pRBC-plasma perfusate, followed by pRBC-crystalloid and then whole blood across oxygen-carrying, coagulopathic and circuit flow metrics. Conclusion The technical study of human pRBC- based perfusates supports pRBC-plasma solutions as the superior modality for normothermic perfusion. Utilisation of these solution provides a cost-effective and physiological and provides ex-vivo tissue whilst preserving tissue function and fidelity.