Related Experiment Video
Updated: Aug 24, 2025
Large-Animal Model of Donation after Circulatory Death and Normothermic Regional Perfusion for Cardiac Assessment
Published on: May 10, 2022
Cardiac function unchanged following reanimation with normothermic regional perfusion in donation after circulatory
Nicholas W Markin1, M Megan Chacon1, Anthony W Castleberry2
1Division of Cardiac Anesthesiology, Department of Anesthesiology, College of Medicine, University of Nebraska Medical Center, Omaha, Neb.
Insights
Normothermic regional perfusion (NRP) reanimation of donation after circulatory death (DCD) hearts shows no significant functional changes on echocardiography. This suggests DCD allografts are not adversely impacted by ischemia before transplantation.
Area of Science:
- Cardiology
- Transplantation Medicine
- Surgical Innovation
Background:
- Donation after circulatory death (DCD) heart transplantation is increasing.
- Normothermic regional perfusion (NRP) is used for DCD heart reanimation.
- The impact of ischemia during DCD withdrawal on cardiac allograft function is unclear.
Purpose of the Study:
- To assess echocardiographic changes in DCD hearts after NRP reanimation.
- To compare pre-arrest and post-NRP cardiac function.
- To determine if warm ischemia affects allograft function.
Main Methods:
- Retrospective review of 4 DCD heart donors (Jan-Oct 2021).
- Echocardiography (2D, speckle-tracking, EF, FAC, GLS) before and after NRP.
- In situ thoracoabdominal NRP reanimation after circulatory death.
Main Results:
- No significant changes in left ventricular ejection fraction (LVEF) or right ventricular fractional area change (RVFAC).
- A minor, non-significant decrease in global longitudinal strain (GLS) observed in some donors.
- No clinically significant functional decline detected post-NRP.
Conclusions:
- NRP reanimation of DCD hearts shows preserved cardiac function on echocardiography.
- Standard donor heart evaluation parameters remain unchanged.
- Limited warm ischemia does not appear to negatively impact DCD allograft function after NRP.
Objectives:
To determine whether hearts reanimated with normothermic regional perfusion (NRP) have clinically detectable changes in function using echocardiography comparing the prearrest and post-NRP imaging. As heart transplantation from donation after circulatory death (DCD) continues to increase, preliminary results suggest outcomes comparable with donation after brain death. It is unknown whether the obligatory period of warm ischemia experienced during DCD withdrawal process causes immediate changes in cardiac allograft function following in situ reanimation.
Methods:
We retrospectively reviewed and compared predonation with postreanimation echocardiographic findings in all DCD donors at our institution from January to October 2021. All DCD donor organs were reanimated with in situ thoracoabdominal NRP after circulatory death. Echocardiographic assessment included (1) 2-dimensional and speckle-tracking measures of chamber size and function; (2) ejection fraction; (3) fractional area change; and (4) global longitudinal strain.
Results:
Altogether, 4 DCD heart donations were performed during the study period. Basic demographics and withdrawal ischemic time periods are reported. There were no changes in left ventricular ejection fraction and right ventricular fractional area change when comparing the predonation and the postreanimation echocardiogram. There was a minimal, nonstatistically significant decrease in left ventricular global longitudinal strain and right ventricular free-wall systolic strain in 3 of the 4 donors following reanimation.
Conclusions:
DCD cardiac allografts reanimated with NRP demonstrated no change in echocardiographic parameters used for a standard predonation donor heart evaluation. Findings suggest cardiac function of DCD allografts reanimated with thoracoabdominal NRP is not adversely impacted by limited period of warm ischemia following circulatory arrest.
