Increasing the acceptance of thoracoabdominal normothermic regional perfusion in donation after circulatory determination of death heart donation: A case for collaborative donor research. - 2026
Increasing the acceptance of thoracoabdominal normothermic regional perfusion in donation after circulatory determination of death heart donation: A case for collaborative donor research.
Louca, John O; Manara, Alex; Shah, Ashishet al.
2026 • In American Journal of Transplantation, 26 (1), p. 13 - 19
DCD; collaboration; donation after circulatory determination of death; donor; ethics; heart transplantation; organ recovery; taNRP; thoracoabdominal normothermic regional perfusion; Humans; Abdomen; Heart Transplantation; Tissue and Organ Procurement/methods; Tissue Donors; Perfusion/methods; Organ Preservation/methods; Death; Organ Preservation; Perfusion; Tissue and Organ Procurement; Immunology and Allergy; Transplantation; Pharmacology (medical)
Abstract :
[en] Donation after circulatory determination of death transplantation offers an effective and safe method of increasing the number of heart transplants performed. Donation after circulatory determination of death heart is ischemic at the time of recovery, and therefore, requires reperfusion. This may take place in the donor, known as thoracoabdominal normothermic regional perfusion (taNRP) or outside of the donor, known as direct procurement and preservation. There is a growing body of evidence that taNRP is associated with better utilization of thoracic and abdominal organs from the donor and with superior recipient outcomes. taNRP offers a cheaper alternative to organ recovery than direct procurement and preservation. In addition, taNRP can also be used in pediatric transplantation. However, there are still concerns regarding the ethical acceptability of taNRP. These concerns center around the possible restoration of brain blood flow during taNRP through collaterals to the vertebrobasilar system. Early studies have demonstrated no brain blood flow or perfusion, but these are limited by small numbers. Further work, with significantly more cases, will need transatlantic collaboration to definitively establish the absence of brain blood flow or perfusion. We have a moral responsibility to both donors and recipients to expedite this work.
Disciplines :
Cardiovascular & respiratory systems Surgery
Author, co-author :
Louca, John O; University of Cambridge, Cambridge Stem Cell Institute, Cambridge, UK, Royal Papworth Hospital, Department of Transplantation, Cambridge, UK, University of Oxford, Nuffield Department of Population Health, Oxford, UK. Electronic address: jol20@cantab.ac.uk
Manara, Alex; Southmead Hospital, Intensive Care Unit, Bristol, UK
Shah, Ashish; Vanderbilt University Medical Center, Department of Cardiac Surgery, Nashville, TN, USA
Schlendorf, Kelly; Vanderbilt University Medical Center, Division of Cardiology, Department of Medicine, Nashville, TN, USA
Lima, Brian; Vanderbilt University Medical Center, Department of Cardiac Surgery, Nashville, TN, USA
Schroder, Jacob; Duke University Medical Center, Department of Surgery NC, Durham, USA
Casalinova, Sarah; Duke University Medical Center, Department of Surgery NC, Durham, USA
Milano, Carmelo; Duke University Medical Center, Department of Surgery NC, Durham, USA
Khush, Kiran; Stanford University, Department of Cardiovascular Medicine, Stanford, CA, USA
Luikart, Helen; Stanford University, Department of Cardiovascular Medicine, Stanford, CA, USA
Darres, Owais; Harefield Hospital (a division of Guys and St Thomas' NHS Foundation Trust), Department of Transplantation, London, UK, School of Cardiovascular Medicine & Sciences Kings College London, UK
Konicoff, Mailen; Harefield Hospital (a division of Guys and St Thomas' NHS Foundation Trust), Department of Transplantation, London, UK
Urban, Marian; University of Nebraska Medical Center, Division of Cardiothoracic Surgery, Department of Surgery, Omaha, NE, USA
Um, John; University of Nebraska Medical Center, Division of Cardiothoracic Surgery, Department of Surgery, Omaha, NE, USA
Castleberry, Anthony; University of Nebraska Medical Center, Division of Cardiothoracic Surgery, Department of Surgery, Omaha, NE, USA
Hoffman, Jordan R H; University of Colorado, Anschutz Medical Center, Department of Surgery, Aurora, CO, USA
Cain, Michael T; University of Colorado, Anschutz Medical Center, Department of Surgery, Aurora, CO, USA
Fetten, Katharina; Baylor Scott and White Health, Baylor University Medical Center, Department of Cardiovascular Surgery, Dallas, TX, USA
Meyer, Dan; Baylor Scott and White Health, Baylor University Medical Center, Department of Cardiovascular Surgery, Dallas, TX, USA
Xu Bsa, Addison; Baylor Scott and White Health, Baylor University Medical Center, Department of Cardiovascular Surgery, Dallas, TX, USA
Gonzalez-Vilchez, Francisco; Hosp Marques de Valdecilla, Department of Cardiology, Instituto de Investigación Valdecilla, Santander, Spain
Domínguez-Gil, Beatriz; Organización Nacional de Trasplantes, Madrid, Spain
Royo-Villanova, Mario; Hospital Universitario Virgen de la Arrixaca, Department of Cardiac Transplantation, Murcia, Spain
Garrido, Iris; Hospital Universitario Virgen de la Arrixaca, Department of Cardiac Transplantation, Murcia, Spain
Brouckaert, Janne; University Hospitals Leuven, Department of Cardiac Surgery, Leuven, Belgium
Rega, Filip; University Hospitals Leuven, Department of Cardiac Surgery, Leuven, Belgium
Vandendriessche, Katrien; University Hospitals Leuven, Department of Cardiac Surgery, Leuven, Belgium
Tchana-Sato, Vincent ; Université de Liège - ULiège > Département des sciences cliniques > Chirurgie cardio-vasculaire
Berman, Marius; Royal Papworth Hospital, Department of Transplantation, Cambridge, UK
Asemota, Nicole; Royal Papworth Hospital, Department of Transplantation, Cambridge, UK
Sinha, Sanjay; University of Cambridge, Cambridge Stem Cell Institute, Cambridge, UK
Pettit, Stephen; Royal Papworth Hospital, Department of Transplantation, Cambridge, UK
Messer, Simon; Golden Jubilee National Hospital, Department of Cardiac Surgery, Glasgow, UK
Öchsner, Marco; Royal Papworth Hospital, Department of Transplantation, Cambridge, UK, LMU University Hospital Munich, Institute for Diagnostic and Interventional Neuroradiology, Munich, Germany
Rubino, Antonio; Royal Papworth Hospital, Department of Transplantation, Cambridge, UK
Parameshwar, Jayan; Royal Papworth Hospital, Department of Transplantation, Cambridge, UK
Bhagra, Sai; Royal Papworth Hospital, Department of Transplantation, Cambridge, UK
Large, Stephen; Royal Papworth Hospital, Department of Transplantation, Cambridge, UK
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