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Croome K, Bababekov Y, Brubaker A, Montenovo M, Mao S, Sellers M, Foley D, Pomfret E, Abt P. American Society of Transplant Surgeons Normothermic Regional Perfusion Standards: Abdominal. Transplantation 2024; 108:1660-1668. [PMID: 39012956 DOI: 10.1097/tp.0000000000005114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
BACKGROUND Normothermic regional perfusion (NRP) has emerged as a vital technique in organ procurement, particularly in donation after circulatory death (DCD) cases, offering the potential to optimize organ utilization and improve posttransplant outcomes. Recognizing its significance, the American Society of Transplant Surgeons (ASTS) convened a work group to develop standardized recommendations for abdominal NRP in the United States. METHODS The workgroup, comprising experts in NRP, DCD, and transplantation, formulated recommendations through a collaborative process involving revisions and approvals by relevant committees and the ASTS council. Four key areas were identified for standardization: Preprocedure communication, NRP procedure, Terminology and documentation, and Mentorship/credentialing. RESULTS The recommendations encompass a range of considerations, including preprocedure communication protocols to facilitate informed decision-making by transplant centers and organ procurement organizations, procedural guidelines for NRP teams, uniform terminology to clarify the NRP process, and standards for mentorship and credentialing of NRP practitioners. Specific recommendations address logistical concerns, procedural nuances, documentation requirements, and the importance of ongoing quality assurance. CONCLUSIONS The standardized recommendations for abdominal NRP presented in this article aim to ensure consistency, safety, and efficacy in the organ procurement process. By establishing clear protocols and guidelines, the ASTS seeks to enhance organ utilization, honor donor wishes, and uphold public trust in the donation process. Implementation of these recommendations can contribute to the advancement of NRP practices and improve outcomes for transplant recipients.
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Affiliation(s)
| | - Yanik Bababekov
- Division of Transplant Surgery, Department of Surgery, University of Colorado, Aurora, CO
| | - Aleah Brubaker
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, University of California San Diego, La Jolla, CA
| | | | - Shennen Mao
- Department of Transplant, Mayo Clinic Florida, Jacksonville, FL
| | | | - David Foley
- Department of Surgery, University of Wisconsin, Madison, WI
| | - Elizabeth Pomfret
- Division of Transplant Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Denver, CO
| | - Peter Abt
- Transplant Division, Department of Surgery, University of Pennsylvania, Philadelphia, PA
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Bernat JL, Khush KK, Shemie SD, Hartwig MG, Reese PP, Dalle Ave A, Parent B, Glazier AK, Capron AM, Craig M, Gofton T, Gordon EJ, Healey A, Homan ME, Ladin K, Messer S, Murphy N, Nakagawa TA, Parker WF, Pentz RD, Rodríguez-Arias D, Schwartz B, Sulmasy DP, Truog RD, Wall AE, Wall SP, Wolpe PR, Fenton KN. Knowledge gaps in heart and lung donation after the circulatory determination of death: Report of a workshop of the National Heart, Lung, and Blood Institute. J Heart Lung Transplant 2024; 43:1021-1029. [PMID: 38432523 PMCID: PMC11132427 DOI: 10.1016/j.healun.2024.02.1455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/07/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024] Open
Abstract
In a workshop sponsored by the U.S. National Heart, Lung, and Blood Institute, experts identified current knowledge gaps and research opportunities in the scientific, conceptual, and ethical understanding of organ donation after the circulatory determination of death and its technologies. To minimize organ injury from warm ischemia and produce better recipient outcomes, innovative techniques to perfuse and oxygenate organs postmortem in situ, such as thoracoabdominal normothermic regional perfusion, are being implemented in several medical centers in the US and elsewhere. These technologies have improved organ outcomes but have raised ethical and legal questions. Re-establishing donor circulation postmortem can be viewed as invalidating the condition of permanent cessation of circulation on which the earlier death determination was made and clamping arch vessels to exclude brain circulation can be viewed as inducing brain death. Alternatively, TA-NRP can be viewed as localized in-situ organ perfusion, not whole-body resuscitation, that does not invalidate death determination. Further scientific, conceptual, and ethical studies, such as those identified in this workshop, can inform and help resolve controversies raised by this practice.
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Affiliation(s)
- James L Bernat
- Department of Neurology, Dartmouth Geisel School of Medicine, Hanover, New Hampshire.
| | - Kiran K Khush
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Sam D Shemie
- Division of Critical Care Medicine, Montreal Children's Hospital, McGill University, Montreal, PQ, Canada
| | - Matthew G Hartwig
- Division of Thoracic Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina
| | - Peter P Reese
- Center for Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anne Dalle Ave
- Kennedy Institute of Ethics, Georgetown University, Washington, District of Columbia
| | - Brendan Parent
- Division of Medical Ethics and Department of Surgery, NYU Grossman School of Medicine, New York, New York
| | - Alexandra K Glazier
- Brown University, School of Public Health, Providence, Rhode Island; New England Donor Services, Waltham, Massachusetts
| | - Alexander M Capron
- Gould School of Law and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Matt Craig
- Lung Biology and Disease Branch, National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Teneille Gofton
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Elisa J Gordon
- Department of Surgery, Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrew Healey
- Department of Medicine McMaster University and William Osler Health System, Hamilton, Ontario, Canada
| | | | - Keren Ladin
- Research on Ethics, Aging, and Community Health (REACH Lab); Departments of Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts
| | - Simon Messer
- Department of Transplant, Golden Jubilee National Hospital, Clydebank, Scotland UK
| | - Nick Murphy
- Departments of Medicine and Philosophy, Western University, London, Ontario, Canada
| | - Thomas A Nakagawa
- University of Florida College of Medicine-Jacksonville, Department of Pediatrics, Division of Pediatric Critical Care Medicine, Jacksonville, Florida
| | - William F Parker
- Department of Medicine and Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Rebecca D Pentz
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | | | - Bryanna Schwartz
- Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, Bethesda, Maryland; Department of Cardiology, Children's National Medical Center, Washington, District of Columbia
| | - Daniel P Sulmasy
- The Kennedy Institute of Ethics and the Departments of Medicine and Philosophy, Georgetown University, Washington, District of Columbia
| | - Robert D Truog
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital; Center for Bioethics, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Anji E Wall
- Department of Surgery, Baylor University Medical Center, Dallas, Texas
| | - Stephen P Wall
- Ronald O. Perelman Department of Emergency Medicine; NYU Grossman School of Medicine and Department of Population Health, NYU, New York, New York
| | - Paul R Wolpe
- Center for Ethics, Department of Medicine, Emory University, Atlanta, Georgia
| | - Kathleen N Fenton
- Advanced Technologies and Surgery Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, and Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, Maryland
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Brierley J, Pérez-Blanco A, Stojanovic J, Kessaris N, Scales A, Paessler A, Jansen N, Briki A, Gardiner D, Shaw D. Normothermic regional perfusion in paediatric donation after circulatory determination of death-the Oxford position statement from ELPAT. FRONTIERS IN TRANSPLANTATION 2024; 3:1320783. [PMID: 38993761 PMCID: PMC11235291 DOI: 10.3389/frtra.2024.1320783] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/12/2024] [Indexed: 07/13/2024]
Affiliation(s)
- J. Brierley
- Paediatric Intensive Care and Bioethics Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | | | - J. Stojanovic
- Department of Paediatric Nephrology and Transplantation, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - N. Kessaris
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - A. Scales
- NHS Blood and Transplant, Bristol, United Kingdom
| | - A. Paessler
- Department of Paediatric Nephrology and Transplantation, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - N. Jansen
- Policy Department, Dutch Transplant Foundation, Leiden, Netherlands
| | - A. Briki
- Paediatric Intensive Care and Bioethics Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - D. Gardiner
- Intensive Care Unit, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - D. Shaw
- Department of Health, Ethics & Society, Maastricht University, Maastricht, Netherlands
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Beckerman Z, Overbey D, Bryner BS, Schroder JN, Andersen ND, Carboni MP, Casalinova S, Turek JW. Infant heart transplant following donation after circulatory death using normothermic regional perfusion and distant transport, first reported case in North America. JTCVS Tech 2023; 20:156-157. [PMID: 37555051 PMCID: PMC10405160 DOI: 10.1016/j.xjtc.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 08/10/2023] Open
Affiliation(s)
- Ziv Beckerman
- Duke Children’s Pediatric & Congenital Heart Center, Duke University Medical Center, Durham, NC
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Douglas Overbey
- Duke Children’s Pediatric & Congenital Heart Center, Duke University Medical Center, Durham, NC
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Benjamin S. Bryner
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | | | - Nicholas D. Andersen
- Duke Children’s Pediatric & Congenital Heart Center, Duke University Medical Center, Durham, NC
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Michael P. Carboni
- Duke Children’s Pediatric & Congenital Heart Center, Duke University Medical Center, Durham, NC
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Sarah Casalinova
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Joseph W. Turek
- Duke Children’s Pediatric & Congenital Heart Center, Duke University Medical Center, Durham, NC
- Department of Surgery, Duke University Medical Center, Durham, NC
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