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Glossary Term

Normothermic regional perfusion (NRP)

  1. A surgical technique which 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. (AST Key Position Statement on Normothermic Regional Perfusion, 2022)
  2. Thoracoabdominal normothermic regional perfusion for donation after circulatory determination of death (TA-NRP DCD) utilizes oxygenated machine perfusion for the preservation of abdominal and thoracic organs rather than standard cold perfusion.  After the donor has been pronounced and confirmed dead, and after waiting 2 to 5 minutes after the determination of circulatory death to ensure the decedent does not spontaneously resuscitate, the TA-NRP DCD procedure involves opening the chest, central cannulation, clamping of the brachiocephalic vessels and initiation of normothermic oxygenated perfusion to the organs that will be used for transplantation. The procurement proceeds in the same fashion as a brain-dead donor. (ASTS Statement on Thoracoabdominal Normothermic Regional Perfusion Donation after Circulatory Determination of Death, 2022)
  3. Normothermic regional perfusion (NRP) in organ recovery from donation after circulatory determination of death (DCDD) donors is an emerging procedure in the United States which uses extracorporeal means to perfuse transplantable organs with oxygenated autologous blood. NRP is initiated after death is declared based on cessation of the donor’s circulatory function. NRP has been documented to improve utilization of organs for transplant and improve recipient patient outcomes compared to traditional, “rapid-recovery,” of organs from DCDD donors. Because NRP is an organ donation procedure, it is of tremendous importance for organ procurement organizations (OPOs) to be involved in the review, development, and implementation of NRP into practice. Two NRP techniques exist: (1) thoracoabdominal NRP (TA-NRP) and (2) abdominal NRP (A-NRP). TA-NRP involves cannulation of the right atrial appendage and ascending aorta for evaluation of the heart for transplantation (abdominal organs benefit from this technique and are usually recovered as well), whereas A-NRP involves perfusion and recovery of abdominal organs (thoracic organs are not perfused but may also be recovered in standard rapid fashion). The distinction between TA-NRP and A-NRP is relevant to specific protocol components that implicate different legal and ethical considerations. Abdominal-only organ recovery can also be done with right atrial appendage and ascending aortic cannulation, and this technique is legally and ethically viewed the same as TA-NRP. (AOPO Statement on Normothermic Regional Perfusion, 2022)

 

 

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