Maintaining the Permanence Principle of Death During Normothermic Regional Perfusion in Controlled Dcd: Results of a Prospective Clinical Study

Abstract Purpose The use of normothermic regional perfusion (NRP) in donation after the circulatory determination of death (DCD) is limited by concerns associated with the reestablishment of circulation after death declaration. The aim of this study is to confirm that certain technical maneuvers applied during NRP preclude circulation to the brain. Methods A non-randomized trial was performed at two Spanish centers. Consecutive adult controlled DCD donors were included. In abdominal NRP (A-NRP), the thoracic aorta was blocked with an intra-aortic occlusion balloon. In thoraco-abdominal NRP (TA-NRP), the arch vessels were clamped and the cephalad ends vented to the atmosphere. Blood from the vented arch vessels drained to the thorax. The mean intracerebral arterial blood pressure (ICBP) was invasively measured at the circle of Willis. Results Ten cDCD donors subject to A-NRP (n = 8) and TA-NRP (n = 2) were included. Mean ICBP and mean blood pressure at the thoracic and the abdominal aorta during the circulatory arrest were 16.9 (SD:3.0), 17.2 (SD:3.0) and 17.6 (SD:4.4), respectively. When A-NRP was started, pressure at the abdominal aorta increased to 49.9 (SD:12.5) mmHg, while the ICBP remained unchanged. When TA-NRP was initiated, pressure at the thoracic aorta reached values of 70.5 (SD:17.7) mmHg, but the ICBP remained unmodified. Registered values of ICBP during NRP were 10 mmHg. Conclusion Appropriate technical measures applied during NRP preclude circulation to the brain in DCD procedures. This study can help to expand NRP, respecting the dead donor rule and increasing the number and quality of organs available for transplantation.