Enhancingc Opportunities through Normothermic Regional Perfusion

Can normothermic regional perfusion (TA-NRP) potentially increase the number of lung transplant recipients? Researchers at the Annual Meeting and Scientific Sessions of the International Society for Heart and Lung Transplantation (ISHLT) in Prague suggest that re-perfusing the lungs of an organ donor after irreversible cessation of heart function could enhance lung transplant opportunities.

TA-NRP involves using a machine to circulate blood through a donor’s abdomen and chest following cardiac arrest, known as donation after circulatory death (DCD). This technique provides perfusion to these areas for 30 to 40 minutes, reviving the heart and ventilating the lungs.

Dr. Pedro Catarino, Director of Aortic Surgery at Cedars-Sinai Medical Center in Los Angeles, anticipates that methods like TA-NRP could facilitate the allocation of donor lungs to patients on transplant waiting lists. Globally, only 20% of available donor lungs are utilized.

Dr. Catarino highlighted the suboptimal utilization of donor lungs, particularly concerning DCD donors, where only four to six percent of lungs are utilized in the US. However, he presented data indicating a retrieval rate of about 15% for DCD lungs with TA-NRP utilization.

Concerns have been raised by some lung experts regarding potential lung injuries during the in situ perfusion process. Dr. Shaf Keshavjee, Director of the Toronto Lung Transplant Program, emphasized the importance of standardizing techniques like TA-NRP to prevent damage to otherwise viable donor lungs.

Currently, TA-NRP is only practiced in the US and Spain, whereas Canada utilizes ex vivo machine perfusion for DCD donor lungs. Machine perfusion has proven successful in the Toronto Lung Transplant Program, which boasts a 40% utilization rate of DCD lungs.

Dr. Catarino emphasized that TA-NRP is a universally applicable technique, unlike machine perfusion, providing the added benefit of measuring oxygen transfer in the lungs to assess donor lung quality.

With promising data suggesting favorable outcomes following TA-NRP for DCD lungs, Dr. Catarino views TA-NRP as a means to address the increasing demand for lung transplants. DCD donors accounted for 32% of overall organ donors in the US in 2022, with a rising trend.

The ISHLT has initiated a task force to compile a statement summarizing the best practices and available evidence for NRP, aiming to address concerns, issues, and areas for future research in the field.