Utilization of Liver Grafts From Donation After Circulatory Death Donors on Extracorporeal Membrane Oxygenation...

Normothermic regional perfusion (NRP) is an organ procurement technique developed for donation after circulatory death (DCD). NRP is associated with better liver transplant outcomes and allows increased risk thresholds for medically complex DCD donors. DCD donors on extracorporeal membrane oxygenation (ECMO) are a category of medically complex donors lacking significant reported experience.

This brief report describes the utilization of liver grafts from ECMO-DCD donors using an NRP procurement technique.

Retrospective analysis of donor and recipient outcomes in 3 cases following abdominal DCD-NRP with ECMO cannula exchange to an NRP circuit. Existing cannulas and tubing can be used for NRP inflow, outflow, or both depending on the configuration.

All donors were older than the age of 50 y and had a functional warm ischemia time of <30 min. NRP duration ranged from 66 to 134 min. All 3 donors demonstrated lactate clearance while on NRP. Recipient age ranged from 52 to 68 and model for end-stage liver disease scores were 22, 26, and 7. All had a 1-d intensive care unit stay and 5- to 7-d total hospital length of stay. One of the 3 recipients had a biliary anastomotic stricture.

This report demonstrates the technical and clinical feasibility of liver transplantation from ECMO-DCD-NRP donors. Preoperative planning for the utilization of existing cannulas, the addition of needed inflow or outflow, and circuit exchange logistics is essential for a smooth transition to NRP in these cases.