**Conflict of interest**

None to declare.

*Normothermic Regional Perfusion in Solid Organ Transplantation DOI: http://dx.doi.org/10.5772/intechopen.84771*

*Advances in Extracorporeal Membrane Oxygenation - Volume 3*

**6. Summary and future directions**

Lung No reports to date

The timing of when cannulation for abdominal NRP may be performed in potential cDCD donors varies by country. In certain countries, such as Spain and the United States, pre-withdrawal heparinization and cannulation are permitted

performed in the least invasive manner possible (e.g., percutaneously).

better quality to a greater number of patients with end-stage organ disease.

[24, 43]. In the United Kingdom, on the other hand, a potential cDCD donor may only be cannulated once death has been declared [25]. Pre-mortem cannulation is advantageous in that it is performed in a less stressful and more orderly fashion, and regional perfusion may be commenced immediately after the death declaration, thereby limiting the length of warm ischemia suffered. Ideally, pre-mortem cannulation should be

**Table 1** summarizes the current state of NRP in the various fields of clinical DCD organ transplantation. The application of post-mortem NRP appears particularly relevant and advantageous in DCD kidney, liver, and heart transplantation, and the future will tell if it can have impact the fields of DCD pancreas and lung transplantation, as well. Some ethical concerns remain surrounding its use, primarily in the context of cDCD, and clear and effective steps need to always be taken to ensure lack of reperfusion of the brain and brainstem once NRP has been initiated. Through these measures and continued dialog with both intensive care as well as extra- and intrahospitalary emergency medical professionals, the hope is that the use of NRP and, thereby, DCD organ transplantation in general may be expanded to offer more organs and ones of

Kidney Lower rates of immediate post-transplantation delayed graft function and

uDCD and cDCD allograft recipients. Liver Lower rates of post-transplantation biliary complications, including ischemic

Pancreas Feasible, though more experience is required to determine its true impact

Heart Less early allograft dysfunction; allows for *in situ* functional assessment that

the use of NMP altogether

*Clinical results observed to date with application of normothermic regional perfusion in donation after* 

primary non-function and improved ongoing graft function among both

type biliary lesions, and less graft loss among cDCD livers; considered

can not only help avoid subsequent costly and potentially unsuccessful *ex situ* normothermic machine perfusion functional assessment but perhaps even

essential for the evaluation and recovery of uDCD livers

**194**

**Conflict of interest**

*circulatory death organ transplantation.*

**Table 1.**

None to declare.
