Surgical Technique of Donation after Circulatory Death using Normothermic Regional Perfusion

Abstract

Heart transplantation (HT) is the gold standard treatment of end-stage heart disease. Waitlist mortality remains high due to a shortage of available donor organs. Donation after circulatory death (DCD) has shown potential to increase transplant volumes by 15%-20%. Resuscitation of the organs after circulatory death can be performed ex vivo using machine perfusion or in situ using either extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass (CPB). Thoracoabdominal normothermic regional perfusion (TA-NRP) entails reperfusing the heart in-situ after circulatory death. It also involves total body reperfusion under physiological conditions, correction of metabolic abnormalities, and allows unloading of the left ventricle to facilitate myocardial recovery. After weaning off support, direct visual and hemodynamic assessment of heart function is possible. Safe and expeditious establishment of cardiopulmonary bypass after death is the key to success of this technique. Here, we review the history of donation after circulatory death, our protocol and surgical technique of establishing TA-NRP with cold static preservation, and briefly describe the outcomes after DCD heart transplantation.