**Acknowledgements**

**6.3. Normothermic regional perfusion**

174 Organ Donation and Transplantation - Current Status and Future Challenges

between the two methods.

**7. Conclusions**

Normothermic Regional Perfusion (NRP) of the abdomen was initially utilized in Spain in the uncontrolled DCD setting, and has since been utilized in the controlled DCD setting in other European countries and Asia [134–138]. The donor's systemic arterial and venous systems are rapidly cannulated, and an *ex vivo* pump/oxygenator system is used to maintain an effective artificial circulation of the abdominal viscera. Cerebral and thoracic perfusion is avoided by clamping the supra-celiac aorta. This system reduces the organ's warm ischemic insult, and proposed benefits include facilitation of a more effective subsequent *in situ* cold flush, ATP replenishment, and reduced oxidative stress [139]. Current experience for NRP exists mainly in the sphere of kidney and liver transplantation. However, utilization of this technique for DCD pancreas preservation and transplantation is appealing, especially because DCD pancreata can have sustained, long-term graft function (as discussed above). Within the UK, five pancreata have been procured after initial NRP, resulting in two SPK transplants and one islet cell transplantation [136]. In Spain, one NRP pancreas has been transplanted in the context of a controlled DCD donor [140]. Future studies are required to more effectively classify evidence for this strategy, and define its comparative role or efficacy with respect to MP. In the DCD setting, NRP may prove to be a more feasible strategy than MP owing to the aforementioned difficulties of maintaining a pancreas on an *ex vivo* machine circuit, although no direct comparisons exist

This chapter outlines the numerous advances that have occurred over the past few decades in pancreas retrieval techniques for both whole organ and cellular transplantation. It clearly demonstrates the improved outcomes in both whole pancreas and islet cell transplantation from significant improvements to organ donor selection and management, and organ perfusion and retrieval surgery. We have seen insulin independence rates for more than 10 years post-transplant in both settings with minimal complications. Whole organ transplantation is obviously now a well-accepted clinical therapy for many patients worldwide. However, islet transplantation still has limited application to the broader population of patients with T1D due to its reliance on the availability of cadaveric donors and selection, isolation results and transplant engraftment, the side effects of immunosuppression and issues associated with the requirement for lifelong immunosuppression. The future holds many interesting potential new therapies that may or may not yield appropriate and safe methods for treatment of type 1 diabetes. From what has been outlined in this chapter we can see that outcomes for patients have improved significantly. If, unfortunately, patients cannot be treated prior to the advent of their type 1 diabetes then they can still be treated by transplantation. Moving forward, researchers and clinicians have numerous fronts and multiple strategies arising at different stages of development in which to be able to offer patients treatments tailored to them and their disease. In the foreseeable future, transplantation and in particular the focus on organ retrieval and organ preservation will play a significant role in further improving outcomes, particularly with newer technologies such as machine perfusion and normothermic regional perfusion. Such technologies are hoped to increase both the The authors wish to thank Callista Rainey for assistance with the figures in this chapter. The authors also wish to acknowledge support from the Royal Australasian College of Surgeons (Sir Roy McCaughey Surgical Research Fellowship).
