In March 2025, Dr. Douglas Overbey presented an Alliance Advancement Series webinar program, “From Challenges to Solutions: The Future of NRP in Pediatrics and Beyond.”
Since this session, Duke Children’s has published an article in the New England Journal of Medicine. In addition, the following letter has been shared from Dr. Joseph Turek and Dr. Douglas Overbey at Duke Children’s Pediatric & Congenital Heart Center:
July 16, 2025
To Whom It May Concern,
I hope this letter finds you well. As a national leader in transplantation, Duke University Medical Center deeply values our partnerships with OPOs across the country. Together, we have made significant strides in expanding access to life-saving transplants.
I am writing to share more on an innovative technique developed at Duke to increase the utilization of donation after circulatory death (DCD) hearts—particularly in pediatric cases where thoracoabdominal normothermic regional perfusion (NRP) is not permitted, and the donor heart is too small for existing ex situ preservation devices.
While we continue to advocate for NRP in donors under 40 kg when permitted by hospital policy, we recognize that institutional restrictions can limit its use. To address this gap, Duke has developed and implemented On Table Reanimation (OTR)—a technique that avoids in situ reanimation altogether. The heart is procured using direct procurement and then reanimated ex situ on the back table for functional assessment prior to transport to the recipient center.
This approach is especially critical in pediatric transplantation, where donor heart size may not be compatible with current preservation systems. OTR allows for functional evaluation and use of these hearts that would otherwise go unused in donors as small as 2.5 kilograms.
This technique was recently published in The New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMoa2503487
We are eager to collaborate with your team to identify potential opportunities for OTR implementation. In some cases, our patients may still be in the evaluation phase and not yet listed in UNET, so they would not appear on a match run. If you have a potential donor, please don’t hesitate to contact us. We can let you know if a suitable candidate is approaching listing. A formal match run will still be required, but early awareness can help ensure no opportunity is missed.
Thank you for your ongoing commitment to advancing organ donation. We look forward to partnering with you to bring hope and healing to more children and families.
Photos: Top left, Joseph Turek, MD, PhD, chief of pediatric cardiac surgery at Duke Health. Image courtesy of Duke Health. Bottom right, Donor heart before reanimation (left) and donor heart after reanimation (right). Images courtesy of NEJM & Kucera et al.
