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Guidance assessment consultation document for In-situ abdominal normothermic regional perfusion to preserve donor livers during retrieval for transplantation after controlled circulatory death

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2 Information about the procedure

2.1

In-situ abdominal normothermic regional perfusion is a procedure that restores circulation to the abdominal organs of a donor after controlled circulatory death and before their liver is removed. During in-situ abdominal normothermic regional perfusion, instead of immediately cold flushing the organ, the donor is first connected to a machine to establish an extracorporeal membrane oxygenation circuit. This machine is made up of a pump, oxygenator and heater. It perfuses the abdominal organs with an oxygenated blood supply at body temperature for about 2 hours after the donor's death. A clamp is placed across the descending thoracic aorta to prevent blood flow to the brain. During the procedure, blood gas and biochemistry tests can be done to assess the function of the liver in real time before it is retrieved. Once the liver is removed, current practice is followed before transplantation.

2.2

The aim of in-situ abdominal normothermic regional perfusion is to reduce the ischaemic damage that occurs during the liver retrieval process and stop this damage becoming irreversible during the subsequent cold-storage process. This means that the liver can recover to its best possible condition before storage, so that it is suitable for transplantation.