Normothermic regional perfusion mobile teams in controlled donation after circulatory death pathway: Evidence and peculiarities

doi:10.5500/wjt.v14.i4.97860

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World Journal of Transplantation

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World J Transplant. Dec 18, 2024; 14(4): 97860
Published online Dec 18, 2024. doi: 10.5500/wjt.v14.i4.97860

Normothermic regional perfusion mobile teams in controlled donation after circulatory death pathway: Evidence and peculiarities

Chiara Lazzeri, Manuela Bonizzoli, Giuseppe Feltrin, Adriano Peris

Chiara Lazzeri, Department of Emergency, Extracorporeal Membrane Oxygenation Center, Regional Transplant Center, Florence 50134, Italy

Manuela Bonizzoli, Adriano Peris, Department of Emergency, Extracorporeal Membrane Oxygenation Center, Florence 50134, Italy

Giuseppe Feltrin, Centro Nazionale Trapianti, Roma 00161, Italy

Author contributions: Lazzeri C, Feltrin G, and Peris A contributed to conceptualization and writing draft; Bonizzoli M contributed to revision of data; All contributed to revision and approval of the final version.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/

Corresponding author: Chiara Lazzeri, MD, Chief Physician, Senior Researcher, Department of Emergency, Extracorporeal Membrane Oxygenation Center, Regional Transplant Center, Largo Brambilla 3, Florence 50134, Italy. lazzeri.ch@gmail.com

Received: June 11, 2024
Revised: July 22, 2024
Accepted: August 6, 2024
Published online: December 18, 2024
Processing time: 101 Days and 0.2 Hours

Abstract

To facilitate the implementation of controlled donation after circulatory death (cDCD) programs even in hospitals not equipped with a local Extracorporeal Membrane Oxygenation (ECMO) team (Spokes), some countries and Italian Regions have launched a local cDCD network with a ECMO mobile team who move from Hub hospitals to Spokes for normothermic regional perfusion (NRP) implantation in the setting of a cDCD pathway. While ECMO teams have been clearly defined by the Extracorporeal Life Support Organization, regarding composition, responsibilities and training programs, no clear, widely accepted indications are to date available for NRP teams. Although existing NRP mobile networks were developed due to the urgent need to increase the number of cDCDs, there is now the necessity for transplantation medicine to identify the peculiarities and responsibility of a NRP team for all those centers launching a cDCD pathway. Thus, in the present manuscript we summarized the characteristics of an ECMO mobile team, highlighting similarities and differences with the NRP mobile team. We also assessed existing evidence on NRP teams with the goal of identifying the characteristic and essential features of an NRP mobile team for a cDCD program, especially for those centers who are starting the program. Differences were identified between the mobile ECMO team and NRP mobile team. The common essential feature for both mobile teams is high skills and experience to reduce complications and, in the case of cDCD, to reduce the total warm ischemic time. Dedicated training programs should be developed for the launch of de novo NRP teams.

Keywords: Controlled donation after circulatory death; Extracorporeal membrane oxygenation; Normothermic regional perfusion; Mobile teams; Warm ischemia time

Core Tip: To facilitate the implementation of controlled donation after circulatory death (cDCD) programs even in hospitals not equipped with a local Extracorporeal Membrane Oxygenation (ECMO) team, normothermic regional perfusion (NRP) mobile teams have been developed, mainly by the “conversion” of existing mobile ECMO teams. We summarized existing evidence on NRP teams with the goal of identifying the characteristic and essential features of a NRP mobile team for a cDCD program, especially for those centers starting the program.