36 - Implementation of Abdominal Normothermic Regional Perfusion at Level 1 Trauma Center

Description:

Introduction: The continuing shortage of deceased donor organs for transplantation and the limited number of potential donors after brain death have led to a resurgence of interest in donation after circulatory death (DCD). The processes of warm and cold ischemia threaten the viability of DCD organs, but these can be minimized by well-organized DCD pathways and new techniques of in situ organ preservation and ex ex-situ resuscitation and repair post-explanation.

In order to improve the quality and function of the organs recovered from DCD donors, a technique called Normothermic Regional Perfusion (NRP) has been developed. This technique is initiated after the donor has been declared dead based on the spontaneous cessation of respiration and circulation. Artificial circulation through a mechanical circulatory device (ECMO) is then initiated to perfuse the organs during recovery. This technique that provides oxygen repletion to organs after a period of prolonged warm ischemia also allows for the assessment of organ function and viability for subsequent transplantation. In 2025, our organization implemented NRP in conjunction with our partnering organ procurement organization (OPO).

This poster seeks to describe the adoption and implementation of abdominal normothermic regional perfusion at a Level 1 Trauma Center in an Urban Setting.

Description of Team: This project was led by the Assistant Manager of the inpatient operating room and Clinical Nurse Leader of the cardiovascular intensive care unit. This project included involvement with the inpatient operating room, intensive care units (MICU, SICU, BICU, NICU, CVICU) and our OPO.

Preparation and Planning: Prior to the implementation of NRP, the organization conducted an ethics review of the potential of including NRP as a standard practice for solid organ donation for DCDs.

Assessment: Nationally, a major increase in DCD donors was noted with 7,820 donors, which was a 23.5% increase over 2023. As a transplant center, in 2024 our organization performed 386 solid organ transplants. Kidneys were the most prevalent solid organ transplant, despite also seeing heart, lungs, liver, and pancreas at the facility. In conjunction with our OPO, we saw 18 donors procured at the organization, resulting in 42 organ transplants.

Implementation: The organization approved the use of NRP for abdominal solid organs exclusively (excluding heart and lungs). The organization's DCD policy was updated to include NRP as a standard practice. Perioperative nursing staff were introduced to NRP through the use of quarterly education sessions conducted by our OPO liaison.

Outcome: Abdominal NRP went live at the organization in 2025. Year to date, a total of two cases have been successfully completed. Outcome metrics to be completed at calendar year end.

Implications for perioperative nursing: As NRP enhances the viability of organs that might otherwise be unsuitable for transplantation due to warm ischemic injury. As the pool of potential donors potentially expands, NRP may allow for more individuals to become organ donors and potentially allow for more solid organ donation after circulatory death. Perioperative nurses will likely encounter more DCD cases and play a crucial role in facilitating NRP process and preparing organs for transplantation. As, NRP requires closed collaboration between the perioperative team, OPOS, and transplant centers, perioperative nurses are at the forefront of this advancement.