Review of Current Normothermic Regional Perfusion Practice in Pediatric Cardiac Donation

Douglas M Overbey; Elizabeth H Stephens; Brendan Parent; Rebecca K Ameduri; Pedro A Catarino; Jennifer Needle; John A Kucera; Fady M Kaldas; Reshma Biniwale; Joseph W Turek

doi:10.1016/j.athoracsur.2024.11.026

Review of Current Normothermic Regional Perfusion Practice in Pediatric Cardiac Donation

Ann Thorac Surg. 2024 Dec 16:S0003-4975(24)01091-9. doi: 10.1016/j.athoracsur.2024.11.026. Online ahead of print.

Authors

Affiliations

¹ Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC; Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC. Electronic address: douglas.overbey@duke.edu.
² Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN.
³ Department of Population Health, NYU Langone Health, New York, NY.
⁴ Department of Cardiac Surgery, Cedars Sinai Medical Center, Los Angeles, CA.
⁵ Department of Pediatrics, Center for Bioethics, University of Minnesota, Minneapolis, MN.
⁶ Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC.
⁷ Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
⁸ Division of Cardiothoracic Surgery, Department of Surgery, UCLA Health Sciences, Los Angeles, CA.
⁹ Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC; Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC.

PMID: 39694216
DOI: 10.1016/j.athoracsur.2024.11.026

Abstract

Background: Cardiac allotransplantation is the optimal treatment for end-stage heart failure. However, organ supply remains the principal issue impacting patients. Pediatric patients present unique challenges resulting in long wait-list times and increased mortality. Donation after circulatory death with normothermic regional perfusion represents a method to increase the number of available organs in this population.

Methods: Multi-institutional expert consultation was sought to outline extant technical, ethical, and logistical issues with regard to normothermic regional perfusion cardiac donation techniques. Specific advantages in the pediatric population are highlighted, as well as technical considerations resulting in successful organ procurement.

Results: Utilization of donation after circulatory death organs following normothermic regional perfusion in the United States is increasing and offers advantages to the pediatric heart failure population. Ethical reservations both nationally and abroad persist, namely pertaining to cerebral blood flow. This has led to variation in perception and utilization of normothermic regional perfusion, contributing to a discrepancy between donor and recipient locations. Procurement techniques and variations are described, with introduction into program planning and protocol development. Training in technical aspects of the procedure is paramount for both the surgeon and support staff to construct a successful program, along with transparent protocols to mitigate ethical concerns.

Conclusions: Normothermic regional perfusion is relevant following donation after cardiac death in the pediatric population. Ethical and technical challenges remain in concert with substantial domestic and international variation. Standardization of technique may serve to increase future use and increase the number of available hearts for transplant, reducing pediatric mortality.

Publication types

Review