Purpose Of Review: Normothermic regional perfusion (NRP) is a novel procurement technique for donation after circulatory death (DCD) in the United States. It was pioneered by cardiothoracic surgery programs and is now being applied to abdominal-only organ donors by abdominal transplant programs. Multiple technical approaches can be used for abdominal-only NRP DCD donors and this review describes these techniques.
Recent Findings: NRP has been associated with higher utilization of organs, particularly liver and heart grafts, from DCD donors and with better recipient outcomes. There are lower rates of delayed graft function in kidney transplant recipients and lower rates of ischemic cholangiopathy in liver transplant recipients. These benefits are driving increased interest from abdominal transplant programs in using NRP for DCD procurements.
Summary: This paper describes the technical aspects of NRP DCD that allow for maximization of its use based on different donor and policy characteristics.
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The Impact of Donor Obesity on Outcomes of Donation After Circulatory Death Heart Transplantation.
J Thorac Cardiovasc Surg
December 2024
Division of Cardiothoracic Surgery, Department of Surgery, Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, VA.
Objectives: In the setting of the obesity epidemic and donor organ shortage in the United States, there's a growing need to expand the donor organ eligibility criteria for orthotopic heart transplantation (OHT). Donation after circulatory death (DCD) has emerged as a promising solution, but the outcomes with obese donor hearts in DCD remains unknown.
Methods: Using the UNOS registry between 2019 and 2024, recipients of DCD OHT were stratified into three donor obesity categories by body mass index (BMI): underweight/normal (BMI <25kg/m), overweight (BMI 25-30kg/m), and obese (BMI >30kg/m).
Outcomes of DCD Liver Transplant Using Sequential Normothermic Regional Perfusion and Normothermic Machine Perfusion or NRP Alone Versus Static Cold Storage.
Transplantation
December 2024
Department of Transplant, Mayo Clinic Florida, Jacksonville, FL.
Background: The availability of in situ normothermic regional perfusion (NRP) or ex situ normothermic machine perfusion (NMP) has revolutionized donation after circulatory death (DCD) liver transplant (LT). While some have suggested that NRP and NMP may represent competing technologies for DCD LT, there are many scenarios where these technologies can function in a complementary manner.
Methods: Between January 2022 and March 2024, 83 DCD LTs were performed using NRP (62 NRP alone and 21 NRP + NMP) and were compared with 297 static cold storage (SCS) DCD LTs.
The role of a hemoadsorption filter on cytokine levels during 1 hour of thoraco-abdominal normothermic regional perfusion for donation after circulatory death heart donation in a porcine model.
Artif Organs
December 2024
Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
Article Synopsis
- Study Purpose
- : The research aimed to determine if using a hemoadsorption device during thoraco-abdominal normothermic regional perfusion (TA-NRP) in heart donation after circulatory death could reduce inflammation and improve heart function.
- Methodology
- : Involved 15 pigs undergoing induced circulatory arrest, followed by TA-NRP with and without a hemoadsorption device. Plasma cytokine levels were measured at various points, and cardiac function was evaluated using pressure-volume loop analysis.
- Findings
- : The hemoadsorption device did not significantly influence cytokine levels or cardiac function post-TA-NRP, indicating that inflammation levels and heart performance were not improved by this intervention
Rise of the machines: Normothermic regional perfusion use in heart transplantation in the United States.
J Thorac Cardiovasc Surg
December 2024
Los Robles Regional Medical Center, Thousand Oaks, Calif. Electronic address:
Background: Normothermic regional perfusion (NRP) and direct procurement and perfusion (DPP) allow for transplantation with donation after circulatory death (DCD) hearts. This study aimed to characterize the use of and variations in NRP and DPP for DCD transplants in the United States.
Methods: Heart transplants performed between December 1, 2019 and March 31, 2024, were identified from the United Network for Organ Sharing database.
Developing a thoracoabdominal normothermic regional perfusion (TA-NRP) program for the recovery of organs for thoracic transplant: lessons from the United States experience.
Ann Cardiothorac Surg
November 2024
Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, CO, USA.
Article Synopsis
- Heart and lung transplantation are important treatments for severe heart and lung failure, but there's a shortage of donor organs, prompting interest in thoracoabdominal normothermic regional perfusion (TA-NRP) to enhance organ availability from circulatory death donors.
- A study evaluated a single-center TA-NRP program, highlighting essential processes and challenges in its adoption, noting an average TA-NRP initiation time of about 7 minutes and overall duration of 87 minutes.
- Key factors for successful implementation included identifying stakeholders, maintaining communication, addressing ethical concerns, and developing care protocols for all phases of the donation process.
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