Maintaining the permanence principle of death during normothermic regional perfusion in controlled donation after the circulatory determination of death: Results of a prospective clinical study

• Published in: American journal of transplantation Vol. 24; no. 2; pp. 213 - 221
• Main Authors: Royo-Villanova, Mario, Miñambres, Eduardo, Sánchez, José Moya, Torres, Eduardo, Manso, Clara, Ballesteros, María Ángeles, Parrilla, Guillermo, de Paco Tudela, Gonzalo, Coll, Elisabeth, Pérez-Blanco, Alicia, Domínguez-Gil, Beatriz
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2024
• Subjects: A-NRP; brain circulation; controlled DCD; Death; death donor rule; Graft Survival; Humans; Organ Preservation - methods; Perfusion - methods; Prospective Studies; TA-NRP; Tissue and Organ Procurement; Tissue Donors; death donor rule; brain circulation; controlled DCD; DBD; A-NRP; TA-NRP; cDCD; BIS; NRP; WLST
• ISSN: 1600-6135; 1600-6143; 1600-6143
• DOI: 10.1016/j.ajt.2023.09.008

One concern about the use of normothermic regional perfusion (NRP) in controlled donation after the circulatory determination of death (cDCD) is that the brain may be perfused. We aimed to demonstrate that certain technical maneuvers preclude such brain perfusion. A nonrandomized trial was performed on cDCD donors. In abdominal normothermic regional perfusion (A-NRP), the thoracic aorta was blocked with an intra-aortic occlusion balloon. In thoracoabdominal normothermic regional perfusion (TA-NRP), the arch vessels were clamped and the cephalad ends vented to the atmosphere. The mean intracranial arterial blood pressure (ICBP) was invasively measured at the circle of Willis. Ten cDCD donors subject to A-NRP or TA-NRP were included. Mean ICBP and mean blood pressure at the thoracic and the abdominal aorta during the circulatory arrest were 17 (standard deviation [SD], 3), 17 (SD, 3), and 18 (SD, 4) mmHg, respectively. When A-NRP started, pressure at the abdominal aorta increased to 50 (SD, 13) mmHg, while the ICBP remained unchanged. When TA-NRP was initiated, thoracic aorta pressure increased to 71 (SD, 18) mmHg, but the ICBP remained unmodified. Recorded values of ICBP during NRP were 10 mmHg. In conclusion, appropriate technical measures applied during NRP preclude perfusion of the brain in cDCD. This study might help to expand NRP and increase the number of organs available for transplantation.