• 16 DCD donors

• 47 organs (29 kidneys, 8 livers, 4 pancreata and 3 lung pairs)

• 37 recipients24 kidneys

8 livers

2 SPK

3 lung transplants

• 3 organs/donor

• Kidney DGF rate 20%

• Organ recovery rate:kidney (93% vs 82%)

liver (50% vs 30%)

lungs (18% vs 4%).

UK NRP experience

Kidney Transplantation

• 24 recipients

• CIT = 12h22’ (5h25’-18h22’).

• DGF rate 20% (50% UK)

(2 donors on CVVH)

Kidney function

0

50

100

150

200

250

300

1 month 3 months 6 months

110 10998

µmol/L

Liver assessment - Biochemistry & Appearance

Oniscu et al, ESOT 2013, Vienna

• Aspect• Bile duct blood flow• PV / HA flows• Gallbladder mucosa aspect• Small bowel appearance

ALT changes on the pump

Liver Transplantation

• 8 recipients

• CIT = 4h10’ (2h49’-6h21’)

• Peak ALT during 1st week : 257 (58-3043).

• One PNF

• No IC ( 2 recip 6/12)

Pancreas transplantation

• 4 pancreata retrieved• 2 SPK – primary function• 1 islet isolation – poor yield• 1 graft research (no islet lab after graft declined by two

centres)

Lung transplantation

• 3 double lungs• Lungs retrieved with cold perfusion• Abdominal warm perfusion

0

10

20

30

40

50

60

70

80

90

100

Organs fromactual DCD

donors

Donor agecriteria met

Consent fororgan donation

Organs offeredfor donation

Organs retrievedfor transplant

Organstransplanted

Per

cent

age

Kidney Liver Pancreas Lungs

Donation and transplantation rates of organs from DCD organ donors in the UK, 1 April 2012 – 31 March 2013

% of all organs

% of all organsmeeting age

criteria

79%

27%

8%6%

79%

27%

14%8%

Transplanted:

Source: Transplant activity in the UK, 2012-2013, NHS Blood and Transplant

Renal Transplantation After Ex Vivo Normothermic Perfusion: The First Clinical StudyS Hosgood, Leicester

• ECD kidneys• Pre-implantation EVNP• DGF 5.6% vs 36.2%• No survival difference

American Journal of Transplantation 2013; 13:1246-52

Ex situ normothermic perfusion

• 10 patients• 6.5-16.5 h preservation• DBD• No biliary complications• 1 pt 6 months

Oxford & King’s College unpublished data

Ex situ normothermic perfusion

• Discarded donor livers• Pulsatile Arterial and continuous PV• 4 hours perfusion• Lactate normalised• Bile production• No hepatocellular ischaemia, biliary injury and sinusoidal

damage

Op den Dries S et al, 2013; 13(5):1327-35.

Annals of Surgery Volume 254, Number 6

Superior Preservation of DCD Livers With ContinuousNormothermic PerfusionConstantino Fondevila, MD, PhD, ∗Amelia J. Hessheimer, MD, ∗Mark-Hugo J. Maathuis, MD, PhD,†Javier Mu˜noz, BS, ∗Pilar Taur´a, MD,‡ David Calatayud, MD, ∗Henri Leuvenink, PhD,† Antoni Rimola, MD, PhD,§ Rutger J. Ploeg, MD, PhD,† and Juan C. Garc´ıa-Valdecasas, MD, PhD∗

90’ CA

4h CS 60’ NRP4h CS

60’ NRP4h NMP

injury, inflammation, and synthetic function

• 20 lungs • 4 hours on the EVLP• Primary graft dysfunction at 72h: 15% vs 30%• No difference in

• mortality• bronchial complications• duration of ventilation• hospital stay

• Case report• Ex situ, warm perfusion of a DCD heart for 12 hours

Twelve-hour Reanimation of a Human Heart Following Donation After Circulatory Death.Rosenfeldt F, Ou R, Woodard J, Esmore D, Marasco S.SourceDepartment of Cardiothoracic Surgery, Cardiac Surgical Research Unit, Alfred Hospital and the Department of Surgery, Monash University, Melbourne, Australia.