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National Collaborative Discussion about Normothermic Regional Perfusion (NRP) Held at Alliance National Critical Issues Forum


Update – March 28, 2023: The on-demand recordings from this program are now available via The Alliance Learning Pathways.

On March 21, 2023, The Alliance, in partnership with the Gift of Life Institute, hosted representatives from across the donation and transplantation community of practice for a specialized one-day summit on the evolving state of normothermic regional perfusion (NRP) – an approach to saving more lives by creating more available hearts for transplantation and improving the quality of other transplantable organs through reducing warm ischemic time. More than 230 leaders gathered in Philadelphia to discuss the current opportunities and challenges associated with this new approach.

“The Institute is so proud to be able to partner on this initiative,” said Richard Hasz, President of Gift of Life Institute. “We have, over our last 20 years, trained almost 18,000 OPO staff on various aspects of donation and transplantation. One of our first offerings was on DCD donation, and so we’ve come back full circle talking about DCD in a different way. I hope it will spark some great conversation and really lead to moving this field forward.”

This collaborative summit included many different perspectives on NRP, and was a fast-paced exploration of legal, ethical, financial and clinical aspects, as well as the impacts to donor management and hospital relationships. Prior to the event, The Alliance distributed a curated resource page with an extensive list of resources and published papers for all attendees to have background prior to arrival.

After a welcome from Karri Hobson-Pape, Executive Director of The Alliance, Jan Finn, President & CEO of Midwest Transplant Network and 2023 Chair of the Alliance Board of Directors, and Richard Hasz, a productive program ensued.

“[The Alliance] was formed across the healthcare sector to bring in a lot of different viewpoints – people that were strong in donation and transplantation – to make sure that we continue to learn,” said Finn.  “I believe The Alliance has brought forth this very current topic to carry out that mission.”

Co-Chairs, Dr. Amit Mathur, Mayo Clinic in Arizona, and Brad Adams, President & CEO of Southwest Transplant Alliance, began the morning by framing the current status of NRP and challenges that will require greater collaboration.

“We have put together a panel of really excellent speakers and experts in a variety of disciplines that touch on NRP,” said Dr. Mathur. “But most importantly, we’ll have an opportunity to discuss things with each other to share what we have learned and are learning as the field evolves.”

“This is an incredible day,” said Adams as he welcomed the audience. “The survey results [obtained during the registration process] revealed that there are many different viewpoints about this, and in designing today, we really wanted to have a space where all of those voices were welcomed and heard. I can’t think of a better organization to be having this conversation than The Alliance because it’s an organization that commits itself to an objective and unbiased presentation on any topic.”

Presentations began with a historical overview of donation following circulatory death (DCD) and NRP, presented by Howard Nathan, Founder and Executive Director of Gift of Life Institute, and Dr. Amit Mathur.

Next, moderated by Dr. Amit Mathur, the abdominal overview came from Dr. Aleah Brubaker from UC San Diego and Dr. Anji Wall from Baylor University Medical Center, with a focus on the OR/Central Cannulation Technique and Femoral Cannulation & ICU Pathway Technique.  In addition, an important international perspective from Dr. Amelia Hessheimer of Spain’s Hospital Universitario La Paz, who focused on the outcomes, evolution of the technique, and national adoption.

Following the abdominal overview, the next panel focused on clinical considerations of thoracic NRP. John Edwards of Gift of Life Donor Program, Dr. John Trahanas of Vanderbilt University Medical Center, Dr. Jordan Hoffman of the University of Colorado and Dr. Victor Pretorius of UC San Diego Health, provided an overview and the NRP program set-up, logistical considerations, essential communication outcomes, and national adoption.

A valuable session, led by Brendan Parent, NYU Langone Health, reviewed the current neuroscience and research perspective and known outcomes. Dr. Marat Slessarev of Western University (Canada) shared his current research perspective.

Logistical considerations were then explored from a transplant center perspective and OPO perspective. Critical perspectives were reviewed regarding communications and messaging across the continuum. This panel was moderated by Jeffrey Trageser, LifeSharing, and included Dr. Kristopher Croome, Mayo Clinic Florida; John Edwards, Gift of Life Donor Program and Janice Whaley, Donor Network West.

The afternoon sessions kicked off with a focus on financial and organizational considerations from hospital leadership, OPO finance and transplant finance perspectives. This panel was moderated by Dr. Anji Wall and included Nancy Foster, American Hospital Association; Jeffrey Trageser; and Dr. Giuliano Testa, Baylor Scott & White Health.

Following the organizational considerations, the afternoon focused on legal and ethical considerations. The legal panel was moderated by Brad Adams, Southwest Transplant Alliance, and included Christina Strong, Dilworth Paxon LLP, and Alexander M. Capron, University Professor Emeritus from the University of Southern California.

The ethical discussion was moderated by Brad Adams, and included Brendan Parent, Dr. Anji Wall and Dr. Matthew DeCamp, University of Colorado Denver.

Following the full day of discussion, the national associations that have provided statements to date on NRP were represented on the closing panel to understand the major considerations that led to the current statements. Organizations represented were the American Society of Transplantation (AST) – Kevin Myer;  the Association of Organ Procurement Organizations (AOPO) – Dr. Marty Sellers; the American Society of Transplant Surgeons (ASTS) – Dr. Anji Wall; and the American College of Physicians (ACP) – Dr. Matthew DeCamp.

Co-Chairs Dr. Amit Mathur and Brad Adams wrapped up the day with an audience discussion regarding key insights and key steps as the community looks to the future.

The Alliance will share recordings of all discussions within the next week through an NRP-focused Learning Pathway, which will carry 6.5 CME, 6.5 CEPTC, and 6.5 Nursing credits.

The planning committee for this program included co-chairs Dr. Amit Mathur and Brad Adams, John Edwards, Theresa A. Daly, Howard Nathan, Brendan Parent, Jeffrey Trageser, and Dr. Anji Wall.

Brendan Parent, Leading Donation and Transplantation Ethicist is Good at Asking Questions
Online Learning Pathways Benefit Organ Donation and Transplantation Professionals with Designated Learning Routes for Critical and Emerging Topics

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