Related Experiment Video
Updated: Aug 15, 2026
Large-Animal Model of Donation after Circulatory Death and Normothermic Regional Perfusion for Cardiac Assessment
Published on: May 10, 2022
Pick your perfusion: National outcomes of normothermic regional perfusion versus direct procurement and perfusion in
Benjamin L Shou1, Corbin E Goerlich1, Alice L Zhou1
1Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
Insights
Normothermic regional perfusion (NRP) offers a modest short-term survival advantage over direct procurement and perfusion (DPP) for donation after circulatory death (DCD) heart transplants. Long-term survival is similar for both strategies once patients overcome the initial perioperative period.
Area of Science:
- Cardiology
- Transplantation Surgery
- Organ Donation
Background:
- Donation after circulatory death (DCD) heart transplantation expands the donor pool.
- Direct procurement and perfusion (DPP) and normothermic regional perfusion (NRP) are debated DCD heart procurement strategies.
Purpose of the Study:
- To compare national outcomes of NRP versus DPP in DCD heart transplantation.
- To evaluate the impact of procurement strategy on short- and long-term survival.
Main Methods:
- Analysis of adult DCD heart transplants from the UNOS registry (Jan 2019 - Mar 2026).
- DPP defined as death-to-cross-clamp interval ≤30 minutes; NRP as >30 minutes.
- One-to-one propensity score matching (PSM) for outcome comparison.
Main Results:
- The cohort included 2,831 DCD heart transplant recipients (61.4% DPP, 38.6% NRP).
- After PSM (939 pairs), NRP showed improved 1-month (97.9% vs 95.8%), 1-year (92% vs 90%), and 3-year (86.9% vs 83.5%) survival.
- Conditional survival at 1 and 3 years was similar between groups.
Conclusions:
- NRP demonstrated a modest perioperative survival benefit compared to DPP.
- Long-term survival (1 and 3 years) was equivalent between NRP and DPP among survivors of the first month.
Objective:
Donation after circulatory death cardiac transplantation has substantially expanded the donor pool; however, the optimal procurement strategy (direct procurement and perfusion or normothermic regional perfusion) remains actively debated. We compared contemporary national outcomes of normothermic regional perfusion versus direct procurement and perfusion using the United Network for Organ Sharing registry.
Methods:
We analyzed first-time, isolated adult donation after circulatory death heart transplants performed in the United States between January 1, 2019, and March 31, 2026, using the United Network for Organ Sharing Standard Transplant Analysis and Research database. Direct procurement and perfusion and normothermic regional perfusion were defined as a death-to-crossclamp interval 30 minutes or less and more than 30 minutes, respectively. Primary outcomes were 1-month, 1-year, and 3-year all-cause mortality. One-to-one propensity score matching was performed to compare differences in outcomes between direct procurement and perfusion and normothermic regional perfusion.
Results:
The analytic cohort comprised 2831 donation after circulatory death heart transplant recipients: 1737 (61.4%) direct procurement and perfusion and 1094 (38.6%) normothermic regional perfusion. Donation after circulatory death comprised 24.6% of all adult heart transplants performed in the United States in 2025. After propensity score matching, 939 direct procurement and perfusion and normothermic regional perfusion pairs were identified. In the matched cohort, survival was lower after direct procurement and perfusion than after normothermic regional perfusion at 1 month (95.8% vs 97.9%; P = .01), 1 year (90% vs 92%, P = .05), and 3 years (83.5% vs 86.9%, P = .04). One-year survival was similar for those surviving the first month (94.0% for both groups), as was 3-year survival conditional on surviving 1 year (92.7% vs 94.4%, P = .52).
Conclusions:
Normothermic regional perfusion was associated with a modest short-term perioperative survival benefit compared with direct procurement and perfusion. Among recipients who survived the first month and year, 1- and 3-year survivals were similar, respectively.
