title: Normothermic regional perfusion for donation after circulatory death without prior heparinization.
abstract: BACKGROUND
  Over 40% of deceased donors in the UK donate after circulatory death (DCD). Normothermic regional perfusion has been reported to improve outcomes in such donors in Europe and the United States. Unlike the United States, legal and professional requirements in the UK prevent cannulation and heparinization before verification of death, which must be a minimum of 5 min after circulatory arrest. We developed a novel protocol for in situ normothermic regional perfusion (NRP) which complied with these requirements.
  
  
  METHODS
  NRP was achieved by cannulating the aorta and vena cava after death. Donor blood was then warmed and oxygenated using a bespoke extracorporeal membrane oxygenator circuit before return to the donor. A shunt was incorporated into the extracorporeal circuit to permit heparin mixing before oxygenation and warming was commenced to prevent thrombosis of the oxygenator. Normothermic perfusion was continued for 2 hr before in situ cold perfusion with preservation fluid. All organs were subject to static cold storage after recovery.
  
  
  RESULTS
  Eight controlled DCD donors underwent NRP from which 3 livers, 2 pancreases, and 14 kidneys were transplanted. Four livers were not used because of biochemical evidence of hepatocellular damage and one because of cirrhosis. Two kidneys were lost from venous thrombosis before function returned and two developed delayed graft function; all transplanted livers and pancreases had primary function.
  
  
  CONCLUSIONS
  Cannulation and heparinization after circulatory arrest does not prevent successful normothermic regional perfusion. The technique permits evaluation of donor organs before implantation and may improve short-term outcomes.
authors.affiliation: 1 Department of Surgery, Addenbrooke's Hospital, and Cambridge Biomedical Research Centre, Cambridge, United Kingdom. 2 Address correspondence to: Christopher JE Watson, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Butler
authors.forename: Lucy V
authors.initials: LV
authors.lastname: Randle
authors.forename: Christopher Je
authors.initials: CJ
authors.lastname: Watson
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001011:Aorta; D002404:Catheterization; D002423:Cause of Death; D050377:Cold Ischemia; D051799:Delayed Graft Function / Q000209:etiology; D046148:Donor Selection; D004334:Drug Administration Schedule; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects; D008875:Middle Aged; D009926:Organ Preservation / Q000009:adverse effects / Q000379:methods*; D016035:Pancreas Transplantation; D010477:Perfusion / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014684:Venae Cavae; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D006493:Heparin