Normothermic Regional Perfusion in Cardiac Transplantation: Developing a Program

Abstract

<h3>Purpose</h3> Due to donor heart scarcity, heart failure patients are placed on a waitlist for transplantation. Efforts to expand the donor pool are essential to reduce waitlist mortality and add quality of life years. To increase organ utilization and transplantation our institution focused on innovations to allow DCD donor heart transplantation. Our program began utilizing DCD hearts in August 2020 as part of a clinical trial assessing direct procurement and machine perfusion technology. Following research on Normothermic Regional Perfusion (NRP) for DCD organ procurement and assessment, we established a clinical team to utilize this procurement strategy. <h3>Methods</h3> Our NRP program development was led by the Surgical Director and consisted of advanced heart failure fellows, transplant Nurse Practitioner, and transplant recovery specialists. The NRP program was developed in 4 phases. Phase 1: Research and concept development, IRB and and ethics review, and administration approval of NRP. Phase 2: NRP protocol development, donor acceptance criteria, and transportation logistics. Phase 3: Development of mobile cardio-pulmonary bypass system including supplies, specialized training, and construction of NRP procurement team consisting of five trained professionals. Phase 4: Dissemination of NRP protocols and focused education session for OPO and transplant center personnel. After completion of the first NRP heart transplant, all OPO leadership within our DSA were notified of our NRP program activation. <h3>Results</h3> The first remote NRP cardiac case was performed in May 2021 within our local DSA yielding a successful transplant. Our program year to date has completed 28 NRP procurement donor runs; yielding 20 transplants, with 8 aborted (6 did not expire, 1 decline due to quality, and 1 declined due to logistical issues). At present our program has 100% NRP transplant survival and our our annual transplant activity increased by 38%. <h3>Conclusion</h3> The structured development of an NRP program increased transplant volume with excellent short-term outcomes by utilizing previously discarded donor hearts.