Related Experiment Video
Updated: Jun 4, 2025
Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death
Published on: August 15, 2022
Normothermic regional perfusion mobile teams in controlled donation after circulatory death pathway: Evidence and
Chiara Lazzeri1, Manuela Bonizzoli2, Giuseppe Feltrin3
1Department of Emergency, Extracorporeal Membrane Oxygenation Center, Regional Transplant Center, Florence 50134, Italy. lazzeri.ch@gmail.com.
Insights
Mobile normothermic regional perfusion (NRP) teams are crucial for expanding controlled donation after circulatory death (cDCD) programs. This study defines the essential features and responsibilities of these specialized NRP teams, differentiating them from Extracorporeal Membrane Oxygenation (ECMO) teams.
Area of Science:
- Transplantation Medicine
- Organ Donation
- Cardiopulmonary Support
Background:
- Controlled donation after circulatory death (cDCD) programs require specialized mobile teams for implementation in hospitals without local Extracorporeal Membrane Oxygenation (ECMO) support.
- Existing mobile ECMO teams have defined structures, but normothermic regional perfusion (NRP) teams lack clear guidelines, hindering widespread adoption of cDCD pathways.
Purpose of the Study:
- To define the essential characteristics and responsibilities of mobile normothermic regional perfusion (NRP) teams within a cDCD program.
- To highlight the similarities and differences between mobile ECMO and NRP teams.
- To provide guidance for centers establishing new cDCD programs utilizing mobile NRP teams.
Main Methods:
- Comparative analysis of mobile ECMO team structures and functions.
- Review of existing literature and evidence on normothermic regional perfusion (NRP) teams.
- Identification of key features and skill requirements for mobile NRP teams in cDCD settings.
Main Results:
- Mobile ECMO and NRP teams share the common requirement for highly skilled personnel to minimize complications and reduce warm ischemic time in cDCD.
- Distinct differences exist between mobile ECMO and NRP teams, necessitating specific training and protocols for NRP teams.
- The study identifies critical features for effective mobile NRP team operation within cDCD programs.
Conclusions:
- Dedicated training programs are essential for the successful launch and operation of de novo NRP teams.
- Standardizing NRP team composition and responsibilities will facilitate the expansion of cDCD programs globally.
- Mobile NRP teams play a vital role in optimizing organ preservation and increasing donation rates in cDCD.
Abstract:
To facilitate the implementation of controlled donation after circulatory death (cDCD) programs even in hospitals not equipped with a local Extracorporeal Membrane Oxygenation (ECMO) team (Spokes), some countries and Italian Regions have launched a local cDCD network with a ECMO mobile team who move from Hub hospitals to Spokes for normothermic regional perfusion (NRP) implantation in the setting of a cDCD pathway. While ECMO teams have been clearly defined by the Extracorporeal Life Support Organization, regarding composition, responsibilities and training programs, no clear, widely accepted indications are to date available for NRP teams. Although existing NRP mobile networks were developed due to the urgent need to increase the number of cDCDs, there is now the necessity for transplantation medicine to identify the peculiarities and responsibility of a NRP team for all those centers launching a cDCD pathway. Thus, in the present manuscript we summarized the characteristics of an ECMO mobile team, highlighting similarities and differences with the NRP mobile team. We also assessed existing evidence on NRP teams with the goal of identifying the characteristic and essential features of an NRP mobile team for a cDCD program, especially for those centers who are starting the program. Differences were identified between the mobile ECMO team and NRP mobile team. The common essential feature for both mobile teams is high skills and experience to reduce complications and, in the case of cDCD, to reduce the total warm ischemic time. Dedicated training programs should be developed for the launch of de novo NRP teams.
