First Successful Abdominal Normothermic Regional Perfusion for Liver and Kidney Transplant Following Donation after Circulatory Determination of Death in India

Abstract

A 55-year-old female with motor neuron disease was hospitalized with altered sensorium due to hypercarbia and respiratory acidosis. The family refused ventilatory support, signed “do not attempt resuscitation,” and consented to Donation after Circulatory Determination of Death (DCDD). Following cardiac arrest and no-touch period of 5 min, low-cost hybrid extra-corporeal membrane oxygenator (ECMO) was used with reservoir to establish abdominal Normothermic Regional Perfusion (A-NRP). Functional warm ischemia time was 24 min. The duration of NRP was 4 h and 10 min, during which lactate fell to 1.5 mmol/L. The liver was transplanted into 48-year-old male with cirrhosis of the liver, MELD score was 28. Cold ischemia time (CIT) was 4 h; the patient was extubated in 12 h and discharged from the hospital on day 14. CIT for kidneys was 14 h. Low-cost hybrid ECMO circuit for establishing A-NRP enables the retrieval and transplantation of liver and kidneys in the setting of DCDD.