Thoracoabdominal normothermic regional perfusion in donors with neurological determination of death extends organ donors pool

Abstract

Background

Heart transplantation team of the Heart Institute of the Ministry of Health of Ukraine performs thoracoabdominal normothermic regional perfusion (TA-NRP) procedure for organ preconditioning in marginal donors. Martial law in Ukraine worsens preexisting shortage of donor organs since February 2022. The use of TA-NRP has been shown to be effective in rescucitating organs in donors with circulatory determination of death (CDD), and we hypothesize that TA-NRP can be used to perform in situ organ perfusion in donors with neurological determination of death (NDD) as well, thereby improve organ quality.

Methods

A single centre, retrospective analysis of outcomes after heart transplantation using organs from donors with NDD who underwent TA-NRP for preconditioning from 2022 to 2024 year at the Heart Institute Ministry of Health of Ukraine. The indications for TA-NRP were hemodynamic instability of donors with NDD, characterized by the need for norepinephrine >1.0 μg/kg/h to maintain mean blood pressure >50 mm Hg.

Results

TA-NRP for donor preconditioning was performed in 12 cases (11.3%) of 106 heart transplantations between 2019 and 2023. The average duration of TA-NRP was 124.5 ± 10.1 minutes. Prior to TA-NRP initiation, all donors exhibited metabolic acidosis, hyperkalemia, and hyperlactatemia. The implementation of TA-NRP normalized the acid-base balance, demonstrated by a significant increase in pH (p < .001), correction of base excess (BE) (p < .001), and an increase in bicarbonate levels (HCO3-) (p < .001). TA-NRP also significantly reduced baseline lactate levels from 10.4 ± 2.91 mmol/L to 1.57 ± 0.33 mmol/L (p < .001) and decreased potassium levels (p = .003). Additionally, it led to a significant reduction in donor heart rate (p = .001) and an increase in mean arterial pressure (p = .012), accompanied by a 6.6-fold reduction in donor norepinephrine requirements (p = .003).

Conclusion

The use of TA-NRP in donors with NDD improved organ quality which resulted in 30 days survival rate of 83% and 1-year survival rate of 75% in organ recipients.