A scintigraphic look at the dead donor rule in donation after the circulatory determination of death with the use of normothermic regional perfusion: A single-center interventional trial

Abstract

Normothermic regional perfusion (NRP) has emerged as a transformative method for organ recovery in donation after the circulatory determination of death (DCDD). However, ethical concerns about brain reperfusion during NRP remain, despite the application of preventative measures, such as blocking the aorta in abdominal NRP or clamping and venting the supraaortic vessels in thoraco-abdominal NRP. In this single-center, nonrandomized interventional trial, we assessed brain perfusion during NRP in DCDD procedures, using perfusion scintigraphy with technetium-99m hexamethylpropyleneamine oxime as the radiotracer. All consecutive adult DCDD donors undergoing organ recovery via NRP were included. A portable gamma camera system was used in the operating room to acquire three 5-minute static images of the brain. The radiotracer was injected intravenously after initiating NRP. In total, 20 adult DCDD donors subject to NRP (15 abdominal NRP, 5 thoraco-abdominal NRP) were recruited. No radiotracer uptake was observed in the brainstem or hemispheres, affirming the absence of cerebral perfusion. Our results reinforce the ethical compliance of NRP with the dead donor rule, though larger-scale human studies are needed to conclusively address lingering uncertainties and support its widespread adoption.

Keywords: abdominal normothermic regional perfusion; dead dolor rule; donation after circulatory determination of death; normothermic regional perfusion; scintigraphy; thoraco-abdominal normothermic regional perfusion.