Thoracoabdominal normothermic regional perfusion-approaches to arch vessels and options of cannulation allowing donation after circulatory death multi-organ perfusion and procurement

Abstract

Since 2015, the use of hearts from controlled donation after circulatory death (DCD) donors for transplantation has steadily increased, with short-term outcomes shown to be comparable to those from donation after brainstem death (DBD) (1). Thoracoabdominal normothermic regional perfusion (TA-NRP) has emerged as an effective strategy to rapidly restore perfusion to and optimise the quality of thoracoabdominal organs in situ after circulatory death is confirmed (2). However, implementation of TA-NRP varies between countries and institutions due to differences in ethical considerations, regulatory policies, and legal frameworks surrounding DCD. A primary ethical concern focuses on the potential for blood flow to return to the brain during TA-NRP (3). This paper and associated video demonstrate the three most common approaches to arch vessels and cannulation for TA-NRP, that are adopted by the teams in the United States of America (USA), Spain, and the United Kingdom (UK) (4).