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

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 TANRP 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. & COPY; 2023 International Society for Heart and Lung Transplantation. All rights reserved.

Automated summary

The use of thoracoabdominal normothermic regional perfusion (TA-NRP) in donation after circulatory death (DCD) is an important development in organ donation. However, there have been concerns about the restoration of brain blood flow. In this study, the authors used intraoperative transcranial Doppler (TCD) to assess brain blood flow in two DCD TA-NRP cases and found no evidence of restored blood flow.