Editing Liver transplantation (section)

=== Normothermic Regional Perfusion ===
Donation after circulatory death (DCD) has become an increasingly important source of organs for transplantation, with categories ranging from uncontrolled to controlled DCD ({{proper name|cDCD}}) donors. Despite its growing use, DCD organs generally suffer from warm ischemia injuries, leading to fewer and lower-quality organs compared to those from donation after brain death (DBD).<ref name=":0">{{Citation |last1=J. Hessheimer |first1=Amelia |title=Normothermic Regional Perfusion in Solid Organ Transplantation |date=2019-12-04 |work=Advances in Extracorporeal Membrane Oxygenation - Volume 3 |editor-last=S. Firstenberg |editor-first=Michael |url=https://www.intechopen.com/books/advances-in-extracorporeal-membrane-oxygenation-volume-3/normothermic-regional-perfusion-in-solid-organ-transplantation |access-date=2024-02-15 |publisher=IntechOpen |language=en |doi=10.5772/intechopen.84771 |isbn=978-1-78923-923-2 |last2=Fondevila |first2=Constantino}}</ref> To mitigate these issues, there has been a rising interest in normothermic regional perfusion (NRP), a technique that temporarily restores oxygenated blood flow to organs after death, thereby improving their viability prior to recovery.{{cn|date=July 2024}}

NRP works by reversing the detrimental effects of warm ischemia on cellular energy substrates and antioxidants, thereby reconditioning the organs before transplantation. This technique, often facilitated by extracorporeal membrane oxygenation (ECMO) technology, allows for organ assessment and optimization, reducing the risk of graft failure.<ref name=":0" /> NRP can be established either abdominally or thoracoabdominally, depending on the intended organs for transplantation, with specific techniques and monitoring protocols in place to ensure optimal outcomes.
Clinical outcomes of NRP in DCD organ transplantation have shown promising results, particularly in kidney and liver transplantation, with lower rates of complications and improved graft survival compared to traditional preservation methods.<ref name=":0" /> Through the utilization of NRP, [[Constantino Fondevila|Dr. Fondevila]] et al. at [[Hospital Universitario La Paz]] have achieved successful transplantation of livers that have undergone extensive warm ischemic periods of up to 2.5 hours prior to recovery.<ref>{{Cite journal |last1=Fondevila |first1=C. |last2=Hessheimer |first2=A.J. |last3=Ruiz |first3=A. |last4=Calatayud |first4=D. |last5=Ferrer |first5=J. |last6=Charco |first6=R. |last7=Fuster |first7=J. |last8=Navasa |first8=M. |last9=Rimola |first9=A. |last10=Taurá |first10=P. |last11=Ginés |first11=P. |last12=Manyalich |first12=M. |last13=García-Valdecasas |first13=J.C. |date=July 2007 |title=Liver Transplant Using Donors After Unexpected Cardiac Death: Novel Preservation Protocol and Acceptance Criteria |journal=American Journal of Transplantation |volume=7 |issue=7 |pages=1849–1855 |doi=10.1111/j.1600-6143.2007.01846.x |pmid=17564639 |issn=1600-6135|doi-access=free }}</ref> This has resulted in biliary complication and graft survival rates comparable to those observed in controlled DCD livers that have experienced significantly less warm ischemia.<ref>{{Cite journal |last1=Fondevila |first1=C. |last2=Hessheimer |first2=A.J. |last3=Flores |first3=E. |last4=Ruiz |first4=A. |last5=Mestres |first5=N. |last6=Calatayud |first6=D. |last7=Paredes |first7=D. |last8=Rodríguez |first8=C. |last9=Fuster |first9=J. |last10=Navasa |first10=M. |last11=Rimola |first11=A. |last12=Taurá |first12=P. |last13=García-Valdecasas |first13=J.C. |date=January 2012 |title=Applicability and Results of Maastricht Type 2 Donation After Cardiac Death Liver Transplantation |journal=American Journal of Transplantation |volume=12 |issue=1 |pages=162–170 |doi=10.1111/j.1600-6143.2011.03834.x |pmid=22070538 |issn=1600-6135|doi-access=free }}</ref>

While ethical considerations remain, especially regarding the use of NRP in controlled DCD scenarios, ongoing research aims to address these concerns and expand the application of NRP to other organ types, ultimately increasing the availability of viable organs for transplantation and improving outcomes for patients with end-stage organ disease{{cn|date=July 2024}}