Normothermic regional perfusion mobile teams in controlled donation after circulatory death pathway: Evidence and peculiarities.

Abstract

To facilitate the implementation of controlled donation after circulatory death (cDCD) programs even in hospitals not equipped with a local Extracorporeal Membrane Oxygenation (ECMO) team (Spokes), some countries and Italian Regions have launched a local cDCD network with a ECMO mobile team who move from Hub hospitals to Spokes for normothermic regional perfusion (NRP) implantation in the setting of a cDCD pathway. While ECMO teams have been clearly defined by the Extracorporeal Life Support Organization, regarding composition, responsibilities and training programs, no clear, widely accepted indications are to date available for NRP teams. Although existing NRP mobile networks were developed due to the urgent need to increase the number of cDCDs, there is now the necessity for transplantation medicine to identify the peculiarities and responsibility of a NRP team for all those centers launching a cDCD pathway. Thus, in the present manuscript we summarized the characteristics of an ECMO mobile team, highlighting similarities and differences with the NRP mobile team. We also assessed existing evidence on NRP teams with the goal of identifying the characteristic and essential features of an NRP mobile team for a cDCD program, especially for those centers who are starting the program. Differences were identified between the mobile ECMO team and NRP mobile team. The common essential feature for both mobile teams is high skills and experience to reduce complications and, in the case of cDCD, to reduce the total warm ischemic time. Dedicated training programs should be developed for the launch of de novo NRP teams.