Abdominal normothermic regional perfusion in donation after circulatory death: organ viability or organ preservation?

Transplants from donation after circulatory death (DCD) provide a viable means to deal with the ever-growing shortage of donors but are burdened by a higher rate of complications and graft loss. Dismal results have prompted the application of stricter donor and graft selection criteria and the use of machine perfusion technologies, such as normothermic regional perfusion (NRP). In this review, we first describe the diffusion of NRP worldwide. Next, the role of NRP in liver transplantation is discussed, with a particular focus on graft selection during perfusion and posttransplant outcomes. Finally, we review the clinical studies reporting on NRP in kidney transplantation. The emerging use of NRP with complementary ex-situ machine perfusion is also described. NRP improves organ quality and maintenance before cold preservation, turns the DCD procedure into a more unhurried one, and allows the assessment of organ function following the warm ischemic injury. Moreover, it is beneficial for both the liver and the kidneys from the same donor.