The American Society of Transplantation would like to share its statement regarding Normothermic Regional Perfusion (NRP), a technique sometimes used in organ donation.
WHAT IS NRP?
Donation after circulatory determination of death (DCD) is a well-established practice and has increased the number of available organs for transplant. The DCD process involves the withdrawal of life sustaining support followed by a period of assessment during which time the donor is declared dead on the basis of permanent cessation of circulatory and respiratory function. After death is declared, the donated organs are then procured. In order to improve the quality and function of the organs recovered from DCD donors, a technique called Normothermic Regional Perfusion (NRP) has been developed. This technique is initiated after the donor has been declared dead based on the spontaneous cessation of respiration and circulation. At that time vascular cannulas are placed, and either the thoracic aorta is clamped, or the cerebral vessels are ligated to prevent subsequent blood flow to the brain. Artificial circulation through a mechanical circulatory device (ECMO) is then initiated to perfuse the organs during recovery. This technique that provides oxygen repletion to organs after a period of prolonged warm ischemia also allows for the assessment of organ function and viability for subsequent transplantation. Published reports have demonstrated that NRP use can lead the expansion of the donor organ pool and increased transplant rates.
WHAT IS OUR POSITION?
Legal clarification either through updates to the Uniform Determination of Death Act (UDDA) or other legal advisory or guidance should be developed to remove any perceived misalignment or legal barriers to NRP donation either as a clinical or a research protocol.
REFERENCES
https://doi.org/10.1111/ajt.17066
https://doi.org/10.1111/ajt.17046
https://doi.org/10.1111/ajt.16959
Approved by the AST Board of Directors on August 24, 2022