Early experience with donation after circulatory death heart transplantation using normothermic regional perfusion in the United States

Normothermic Regional Perfusion is an Emerging Cost-Effective Alternative in Donation After Circulatory Death (DCD) in Heart Transplantation

“…In contrast, NRP permits rapid reperfusion and assessment of allograft function under physiological conditions. Smith and colleagues have demonstrated promising outcomes, including weaning all donor hearts off of CPB without inotropes, a 100% recipient survival rate with a median follow-up of approximately one year, a post-discharge left ventricular ejection fraction of 64%, and no patients requiring mechanical circulation support [ 24 ]. Although NRP is resource-intensive and will cost an additional $4000 for each heart assessed for equipment and personnel, compared to OCS, it is more feasible.…”

Logistics for expanding heart transplantation from donation after circulatory death using normothermic regional perfusion

“…We recently reported our experience with 8 DCD-NRP heart transplants (including 1 heart–lung transplant) using this approach, with 100% survival, no significant primary cardiac graft dysfunction, and no need for mechanical circulatory support for cardiac dysfunction in the per-operative period. 5 Although reperfusion and recirculation can be achieved by using closed systems such as ECMO, the advantages offered with open, traditional CPB and unloaded cardiac reperfusion are unique. Previous work has clearly demonstrated the protective impact of reperfusion of the ischemic heart in an unloaded state, which results in less reperfusion injury, improved myocardial salvage, and improved cardiac functional recovery.…”

Commentary: Hope on the horizon: Heart transplantation with donation after circulatory death

“… 3 In addition, the first 3 US series of DCD heart recipient outcomes were recently published in 2021, including a UNOS analysis of 136 DCD heart transplants and 2 institutional series of DCD heart transplant using normothermic regional perfusion (NRP). 4 , 5 , 6 While 6-month mortality after DCD transplant appears to be equivalent to DBD in the UNOS analysis, this may not fully account for bias from a highly selected population of DCD donors and recipients. Not least of all, ongoing dramatic changes in the field of heart transplantation—and a worldwide pandemic—may confound early analyses of DCD heart transplantation.…”