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RESEARCH PRODUCT

Organ Recovery Procedure in Donation After Controlled Circulatory Death with Normothermic Regional Perfusion: State of the Art

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The global shortage of organ donors will not be resolved solely by relying on donation after brain death. Expansion to use of donation after controlled circulatory death will be needed to address the shortfall of organs for transplantation. The processes of warm ischemia threaten the viability of organs obtained after controlled circulatory death, but these can be minimized by well-organized donation pathways and new techniques of in situ organ preservation, such as normothermic regional perfusion. The use of extracorporeal membrane oxygenation (ECMO) devices for normothermic regional perfusion in liver transplantation can help reduce rates of biliary complications, ischemic type biliary lesions, and graft loss, and allow for successful transplantation even from donors of advanced age. The combined method of super rapid recovery for lung transplantation and normothermic regional perfusion for liver transplantation offers an outstanding recovery rate and liver and lung recipient survival comparable with that of patients receiving organs donated after brain death. Marked reductions in delayed graft function have been seen in normothermic regional perfusion donation after controlled circulatory death cohorts suggesting that this is one of the main advantages of this type of kidney transplantation. The use of normothermic regional perfusion for pancreas transplantation is related with good outcomes. Recently, normothermic regional perfusion has also been implemented with successful results in heart transplantation. The assessment of cardiac function during procurement with normothermic regional perfusion allows for an extended age range of donors and has resulted in a greater conversion to heart transplantation than hearts procured with alternative methods.