Lethal Donation: Do Physicians Cause Death or Preserve Organs in NRP-cDCD?

Transplantation, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 10, 2025

1Faculty of Theology, University Oslo, Norway. Received 21 August 2024. Revision received 25 November Accepted 1 December The author declares no funding or conflicts interest. Correspondence: Emil J. N. Busch, MA, Kalundborgvej 177, 4300 Holbæk, Denmark. ([email protected]).

Language: Английский

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Thoraco Abdominal Normothermic Regional Perfusion and Lung Transplantation - Is it a Safe Match?

The Journal of Heart and Lung Transplantation, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 1, 2025

Language: Английский

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Thoracoabdominal normothermic regional perfusion in organ donation: A comprehensive review of current evidence and best practices

Expert Review of Respiratory Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 9, 2025

Keywords: Thoracoabdominal Normothermic Regional PerfusionTA-NRPDonation after circulatory deathDCDlung procurement

Language: Английский

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Thoracoabdominal Normothermic Regional Perfusion: Real-world Experience and Outcomes of DCD Liver Transplantation

Transplantation Direct, Journal Year: 2025, Volume and Issue: 11(3), P. e1767 - e1767

Published: Feb. 28, 2025

Background. Donation after circulatory death liver transplantation (DCD LT) is underused given historical outcomes fraught with ischemic cholangiopathy (IC). We aimed to assess 6-mo IC in LT from DCD via normothermic regional perfusion (NRP) compared static cold storage (SCS). Methods. A retrospective review of adult Maastricht-III donors and recipients at the University Colorado Hospital January 1, 2017, August 27, 2024, was performed. The rate between NRP SCS. Secondary included biochemical assessments accepted versus declined allografts allograft patient survival for SCS groups. Results. One hundred sixty-two LTs (SCS = 79; 97) were performed 150 74; 86) reached follow-up. Six-month lower (1.2% 9.5%, P 0.03). Donor Risk Index (2.44 [2.02–2.82] 2.17 [1.97–2.30], 0.002) UK Score (4.2 ± 2.9 3.2 2.3, 0.008) higher Liver Graft assessment Following Transplantation score less (–3.3 –3.1, < 0.05). There several differences median parameters during livers, including terminal biliary bicarbonate (22.7 [20.9–29.1] 10.8 [7.6–13.1] mEq/L, 0.004). no significant 12-mo or Conclusions. a disruptive innovation that improves utilization livers. Despite higher-risk donor-recipient pairing SCS, we demonstrate decrease NRP. These data facilitate benchmarking thoracoabdominal support further protocol development.

Language: Английский

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Ethical and legal considerations in normothermic regional perfusion for donation after circulatory death

Current Opinion in Critical Care, Journal Year: 2025, Volume and Issue: unknown

Published: March 7, 2025

Purpose of review This study aims to examine the ethical and legal discourse surrounding normothermic regional perfusion (NRP) for donation after circulatory death (DCD). Recent findings NRP is well established within Europe but faces challenges in US not utilized a variety other countries. compliance with dead donor rule (DDR) Uniform Declaration Death Act (UDDA) most significant recently addressed issue. Additionally, procedures raise concerns regarding public education, informed consent, engagement, trust. Inconsistent regulation – such as US– cause concern anticipated increase frequency support organ recovery transplantation. There no single repository technical outcome data practice refinement key aspect given variation between centers Summary NRP-based presents be by transplantation clinicians organizations conjunction representatives. Additional inquiry into determination death, family information needs authorization, coordinated needed ensure that are appropriately addressed. Public engagement essential bolster preserve

Language: Английский

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Thoraco-abdominal normothermic regional perfusion does not restore cerebral blood flow or electrical activity despite collateral supra-aortic blood flow in a porcine model

JHLT Open, Journal Year: 2025, Volume and Issue: unknown, P. 100221 - 100221

Published: Jan. 1, 2025

Language: Английский

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Sustained Absence of Perfusion to the Brain Must Be Ensured During Thoracoabdominal Normothermic Regional Perfusion

Transplantation, Journal Year: 2024, Volume and Issue: 109(1), P. e78 - e78

Published: Dec. 7, 2024

We have read with interest the "Consensus Statement: Technical Standards for Thoracoabdominal Normothermic Regional Perfusion," and applaud Hoffman et al1 providing detailed guidance conduction of thoracoabdominal normothermic regional perfusion (TA-NRP) in donation after circulatory determination death (DCDD). However, we draw attention on 2 specific aspects that may require reformulation. Our concerns relate to most important limitation expansion (NRP)—its consistency dead donor rule. The unified concept reconciles NRP diagnosis but requires sustained absence brain.2 Conceptually practice, this must be accomplished. provide different options excluding brain during TA-NRP are displayed Figure 1 their article. only deem 1a 1b ethically appropriate since 1c 1d do not incorporate measures deviate any potential collateral circulation from brain. Manara al3 were first warn simple clamping or ligation supra-aortic arch vessels might sufficient exclude TA-NRP. In a series 3 cases, where clamped cephalad ends either vented atmosphere drained negative pressure, these authors described continuous flow ends, suggesting diversion Although estimated (up 50 mL/min) was likely insufficient support neuronal activity, observation inspired Spanish protocol practice According our national standard, then cut atmosphere.4 is aspirated surgical field returned circuit. When applying technique, able confirm by invasive monitoring intracranial blood pressure procedures.5 also state there no evidence adjunctive cerebral needed TA-NRP.1 To contrary, strongly recommend neuromonitoring incorporated into protocol. This case Spain multimodal mandatory, gain isolation application above-mentioned technical procedures identify error would lead immediately halting procedure.4 when used, DCDD donors monitored bispectral index transcranial Doppler ultrasound, which can replaced arterial centers conducting previously mentioned research project.5 groundbreaking preservation strategy, it applied based an robust includes elements highlighted correspondence—deviation neuromonitoring. fundamental safe technically complex situ strategy increase organ utilization achieve optimal posttransplant outcomes organs.

Language: Английский

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The role of a hemoadsorption filter on cytokine levels during 1 hour of thoraco‐abdominal normothermic regional perfusion for donation after circulatory death heart donation in a porcine model

Artificial Organs, Journal Year: 2024, Volume and Issue: unknown

Published: Dec. 12, 2024

Both global ischemia caused by circulatory arrest and extracorporeal circulation circuits have been shown to trigger cytokine release. We hypothesized that inserting a hemoadsorption device during thoraco-abdominal normothermic regional perfusion (TA-NRP) in the donation after death setting would mitigate inflammatory response, potentially resulting improved cardiac allograft function.

Language: Английский

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A Novel Technique for Innominate Artery Cannulation in Thoracoabdominal Normothermic Regional Perfusion

JTCVS Techniques, Journal Year: 2024, Volume and Issue: 29, P. 94 - 96

Published: Nov. 30, 2024

Language: Английский

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