Brief Communication
Thoracoabdominal normothermic regional perfusion in donation after circulatory death does not restore brain blood flow

https://doi.org/10.1016/j.healun.2023.05.010Get rights and content

Use of thoracoabdominal normothermic regional perfusion (TA-NRP) during donation after circulatory death (DCD) is an important advance in organ donation. Prior to establishing TA-NRP, the brachiocephalic, left carotid, and left subclavian arteries are ligated, thereby eliminating anterograde brain blood flow via the carotid and vertebral arteries. While theoretical concerns have been voiced that TA-NRP after DCD may restore brain blood flow via collaterals, there have been no studies to confirm or refute this possibility. We evaluated brain blood flow using intraoperative transcranial Doppler (TCD) in two DCD TA-NRP cases. Pre-extubation, anterior and posterior circulation brain blood flow waveforms were present in both cases, similar to the waveforms detected in a control patient on mechanical circulatory support undergoing cardiothoracic surgery. Following declaration of death and initiation of TA-NRP, no brain blood flow was detected in either case. Additionally, there was absence of brainstem reflexes, no response to noxious stimuli and no respiratory effort. These TCD results demonstrate that DCD with TA-NRP did not restore brain blood flow.

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Thoraco-abdominal normothermic regional perfusion (TA-NRP), has made heart transplant possible following donation after circulatory death (DCD), and helped fill an urgent need for organ donors.1 However, ethical concerns have been raised that TA-NRP may restore brain blood flow and, in doing so, violate the dead donor rule.2, 3, 4 Prior to establishing TA-NRP, the brachiocephalic, left carotid, and left subclavian arteries (and/or anomalous right subclavian artery) are ligated, thereby

Disclosure statement

J.A.F., A.L., L.J., K.M., E.R., B.P., S.T.H., D.E.S., and N.M. have no relevant disclosures.

Funding

None.

Author Contributions

J.A.F. collected and analyzed data and drafted the manuscript. A.L., L.J., K.M., B.P., and E.J. participated in study design and data analyses. S.T.H., D.E.S., and N.M. collected data, participated in study design, and critically reviewed the manuscript.

Acknowledgments

The authors thank the donor families for their life-saving gift.

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