Extending normothermic regional perfusion to the thorax in donors after circulatory death

Purpose of review Despite a significant increase in the utilization of donors after circulatory death (DCD), the number of organs recovered and their function are largely inferior to those from donors after brain death. This review summarizes recent advances in in-situ normothermic regional perfusion of DCD organs prior to procurement. Recent findings The combination of warm and cold ischemia in DCD donation are detrimental to organ function. As a consequence, the acceptance criteria are far more restrictive and many organs are discarded. The application of extracorporeal circulation technology to DCD organ retrieval in the form of abdominal normothermic regional perfusion (NRP) made a significant impact on organ procurement. DCD heart transplantation has been made possible by technological developments of ex-situ preservation. Extending NRP to include cardio-thoracic organs is a recent development enabling conversion from a DCD to a donor after brain death-type procurement. NRP offers the opportunity for a dynamic assessment of function and may lead to expansion of acceptance criteria as well as allowing for early interventions to modulate organ function. Summary Thoraco-abdominal NRP may become the new gold standard for DCD organ retrieval. Further research and education are required to streamline logistics, define organ function markers and increase acceptance and utilization.