Overbey Douglas M, Stephens Elizabeth H, Parent Brendan, Ameduri Rebecca K, Catarino Pedro A, Needle Jennifer, Kucera John A, Kaldas Fady M, Biniwale Reshma, Turek Joseph W
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina; Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, North Carolina.
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Ann Thorac Surg. 2025 Jul;120(1):4-14. doi: 10.1016/j.athoracsur.2024.11.026. Epub 2024 Dec 16.
Cardiac allotransplantation is the optimal treatment for end-stage heart failure. However, organ supply remains the principal issue affecting patients. Pediatric patients present unique challenges resulting in long wait-list times and increased mortality. Donation after circulatory death with normothermic regional perfusion represents a method to increase the number of available organs in this population.
Multiinstitutional expert consultation was sought to outline extant technical, ethical, and logistical issues with regard to normothermic regional perfusion cardiac donation techniques. Specific advantages in the pediatric population are highlighted, as well as technical considerations resulting in successful organ procurement.
The use of donation after circulatory death organs after normothermic regional perfusion in the United States is increasing and offers advantages to the pediatric heart failure population. Ethical reservations both nationally and abroad persist, namely pertaining to cerebral blood flow. This issue has led to variation in perception and use of normothermic regional perfusion, thus contributing to a discrepancy between donor and recipient locations. Procurement techniques and variations are described, with an introduction to program planning and protocol development. Training in technical aspects of the procedure is paramount for both the surgeon and support staff to construct a successful program, along with transparent protocols to mitigate ethical concerns.
Normothermic regional perfusion is relevant after donation after cardiac death in the pediatric population. Ethical and technical challenges remain, in concert with substantial domestic and international variation. Standardization of technique may serve to increase future use and increase the number of available hearts for transplantation, thereby reducing pediatric mortality.
心脏同种异体移植是终末期心力衰竭的最佳治疗方法。然而，器官供应仍然是影响患者的主要问题。儿科患者面临独特的挑战，导致等待名单时间长且死亡率增加。循环死亡后常温区域灌注捐献是增加该人群可用器官数量的一种方法。
寻求多机构专家咨询，以概述与常温区域灌注心脏捐献技术相关的现有技术、伦理和后勤问题。突出了儿科人群的具体优势，以及成功获取器官的技术考虑因素。
在美国，循环死亡后常温区域灌注器官的使用正在增加，对儿科心力衰竭人群具有优势。国内外在伦理方面仍存在保留意见，即与脑血流量有关。这个问题导致了对常温区域灌注的认知和使用存在差异，从而造成供体和受体所在地之间的差异。描述了获取技术及变化情况，并介绍了项目规划和方案制定。对于外科医生和支持人员来说，该手术技术方面的培训对于构建一个成功的项目至关重要，同时还需要透明的方案来减轻伦理担忧。
常温区域灌注在儿科人群心脏死亡后的捐献中具有相关性。伦理和技术挑战仍然存在，同时在国内和国际上存在很大差异。技术标准化可能有助于增加未来的使用，并增加可用于移植的心脏数量，从而降低儿科死亡率。
