Normothermic Regional Perfusion is an Emerging Cost-Effective Alternative in Donation After Circulatory Death (DCD) in Heart Transplantation

Abstract

In donation after circulatory death (DCD) organ transplantation, normothermic regional perfusion (NRP) restores oxygenated blood flow following cardiac arrest and reverses warm ischemia. Recently, NRP has also been used to help recover DCD hearts in addition to the abdominal organs. While DCD donation has increased the number of abdominal organs and lungs pool, it has not been able to increase the number of heart transplants, despite the fact that it has the potential to increase the number of heart transplants by 15-30%. Thoracoabdominal normothermic regional perfusion makes heart transplantation feasible and permits assessing heart function before an organ procurement without affecting the preservation of abdominal organs. NRP can be used in two ways for DCD donor heart transplants: normothermic regional perfusion followed by machine perfusion (NRP-MP) and normothermic regional perfusion followed by static cold storage (NRP-SCS). Normothermic regional perfusion is an emerging technology, a cost-effective alternative in donation after circulatory death (DCD), and will increase the pool of donors in heart transplantation.

Keywords: cold storage; donation after circulatory death (dcd); donors pool; heart transplantation; normothermic regional perfusion (nrp); warm ischemia.

Figure 1. Cannulation and circuit for normothermic regional perfusion.

VA-ECMO circuit is the same for both TA-NRP and A-NRP. In TA-NRP, the aorta and right atrium are cannulated; in A-NRP, the femoral artery and femoral vein are cannulated. In addition, the circuit is modified to accommodate two suctions for blood collection. VA-ECMO: veno-arterial extracorporeal membrane oxygenation, TA-NRP: thoracoabdominal normothermic regional perfusion, A-NRP: abdominal-normothermic regional perfusion.

Figure 2. Equipment used in normothermic regional perfusion.

Showing the circuit (A) and cannulation (B) of thoracoabdominal normothermic regional perfusion. (C) shows the required instruments setup on the Mayo stand (USA Medical and Surgical Supplies, St. Louis, MO).