Bilodeau Kyle S, Park Sarah Y, Bashian Elizabeth, Zakko Jason, Cain Michael T, Rove Jessica Y, Reece T Brett, Cleveland Joseph C, Hoffman Jordan R H
Department of Surgery, Division of General Surgery, University of Washington, Seattle, WA, USA.
Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, CO, USA.
Ann Cardiothorac Surg. 2024 Nov 30;13(6):487-494. doi: 10.21037/acs-2024-dcd-0038. Epub 2024 Jul 15.
Heart and lung transplantation remain efficacious treatments for patients with end-stage cardiopulmonary failure. However, donor shortages remain a challenge to both providers and patients. Thoracoabdominal normothermic regional perfusion (TA-NRP) has been increasingly adopted to decrease organ ischemia from circulatory death donors and therefore increase the number of organs available for transplantation. Despite initial success, data on program genesis and implementation are limited. The aim of this manuscript is to characterize essential human resources, lessons, and key considerations needed to improve TA-NRP dissemination and thus adoption.
Single-center evaluation of a TA-NRP program was conducted using a retrospective cohort study design. All procurements performed using TA-NRP were included. Quantitative data were summarized. Descriptive elements of programmatic genesis, implementation, and experience were summarized using an inductive reasoning approach.
Thirty TA-NRP procurements were performed. The average time from incision to TA-NRP initiation was 7±2 minutes and total time on TA-NRP was 87±28 minutes. In simple regression analysis, the average total TA-NRP time was noted to increase by approximately 0.86 minutes per procurement [95% confidence interval (CI): -0.10, 1.82, P=0.08], while the average warm ischemia time was noted to decrease by approximately 0.03 minutes per procurement (95% CI: -0.13, 0.07, P=0.43). Key programmatic elements during planning and implementation were identification of key stakeholders, early communication, proactive navigation of ethical concerns, staffing and equipment needs, and development of TA-NRP algorithms for pre, intra- and post-donation phases of care.
Development of a TA-NRP program is both feasible and easily implemented at institutions with pre-existing organ donation after circulatory death (DCD) procurement experience. Early identification of key stakeholders with frequent communication identified areas in need of expanded resources and addressed early ethical concerns, while local implementation efforts supported operationalization of existing infrastructure for TA-NRP procurements.
心肺移植仍然是终末期心肺功能衰竭患者的有效治疗方法。然而，供体短缺对医疗服务提供者和患者来说都是一项挑战。胸腹常温区域灌注（TA-NRP）已越来越多地被采用，以减少循环死亡供体的器官缺血，从而增加可用于移植的器官数量。尽管取得了初步成功，但关于该项目起源和实施的数据有限。本手稿的目的是描述改善TA-NRP传播从而促进其采用所需的基本人力资源、经验教训和关键考虑因素。
采用回顾性队列研究设计对一个TA-NRP项目进行单中心评估。纳入所有使用TA-NRP进行的器官获取。对定量数据进行总结。使用归纳推理方法总结项目起源、实施和经验的描述性要素。
共进行了30例TA-NRP器官获取。从切开到开始TA-NRP的平均时间为7±2分钟，TA-NRP的总时间为87±28分钟。在简单回归分析中，每次获取的TA-NRP平均总时间增加约0.86分钟[95%置信区间（CI）：-0.10，1.82，P = 0.08]，而每次获取的平均热缺血时间减少约0.03分钟（95%CI：-0.13，0.07，P = 0.43）。规划和实施过程中的关键项目要素包括确定关键利益相关者、早期沟通、积极应对伦理问题、人员配备和设备需求，以及制定捐赠前、捐赠中和捐赠后护理阶段的TA-NRP算法。
在已有循环死亡后器官捐赠（DCD）获取经验的机构中，开发TA-NRP项目既可行又易于实施。通过早期识别关键利益相关者并频繁沟通，确定了需要扩大资源的领域并解决了早期伦理问题，而本地实施工作支持了TA-NRP获取现有基础设施的运作。
