• Alex Manara, Sam D Shemie, Stephen Large, Andrew Healey, Andrew Baker, Mitesh Badiwala, Marius Berman, Andrew J Butler, Prosanto Chaudhury, John Dark, John Forsythe, Darren H Freed, Dale Gardiner, Dan Harvey, Laura Hornby, Janet MacLean, Simon Messer, Gabriel C Oniscu, Christy Simpson, Jeanne Teitelbaum, Sylvia Torrance, Lindsay C Wilson, and Watson Christopher J E CJE 0000-0002-0590-4901 Department of Surgery, University of Cambridge, Cambridge, UK. .
• Southmead Hospital, Bristol, UK.
• Am. J. Transplant. 2020 Aug 1; 20 (8): 2017-2025.

AbstractThere is international variability in the determination of death. Death in donation after circulatory death (DCD) can be defined by the permanent cessation of brain circulation. Post-mortem interventions that restore brain perfusion should be prohibited as they invalidate the diagnosis of death. Retrieval teams should develop protocols that ensure the continued absence of brain perfusion during DCD organ recovery. In situ normothermic regional perfusion (NRP) or restarting the heart in the donor's body may interrupt the permanent cessation of brain perfusion because, theoretically, collateral circulations may restore it. We propose refinements to current protocols to monitor and exclude brain reperfusion during in situ NRP. In abdominal NRP, complete occlusion of the descending aorta prevents brain perfusion in most cases. Inserting a cannula in the ascending aorta identifies inadequate occlusion of the descending aorta or any collateral flow and diverts flow away from the brain. In thoracoabdominal NRP opening the aortic arch vessels to atmosphere allows collateral flow to be diverted away from the brain, maintaining the permanence standard for death and respecting the dead donor rule. We propose that these hypotheses are correct when using techniques that simultaneously occlude the descending aorta and open the aortic arch vessels to atmosphere.© 2020 The Authors. American Journal of Transplantation published by Wiley Periodicals, Inc. on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons.

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