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Extra donor organs thanks to new organ perfusion

In the world of organ transplantation it is called the rise of the machines. Physicians from Erasmus MC and LUMC (Leiden University Medical Center) have recently started using a new device that tests the quality of donor organs in the operating room. They expect that this new working method could generate about 30 extra livers and pancreas per year, thus helping to solve the acute shortage of donor organs. The first liver that became available using this new technique was successfully transplanted at Erasmus MC in October.

The method is called Normothermic Regional Perfusion (NRP), where the donor organs are connected to a blood circulation device during the procedure to retrieve the organs, and takes place after circulatory death of the donor. The device pumps blood at body temperature through the blood vessels in the abdominal cavity with the donor organs. This method offers physicians the opportunity to test the quality of organs that had until now been considered unsuitable for use, and then possibly still transplant them. This technique has not previously been used is the Netherlands, but had already been proven successful in the UK.

First transplantation successful
The first liver transplantation after regional organ perfusion was performed at Erasmus MC in October. The donor liver that was transplanted had initially been rejected by all Dutch centers because of the high risk of dysfunction. The innovative perfusion technique was used to test the functioning of the organ while it was still in the donor, and it was decided to transplant the liver after the positive test results. The liver transplantation was successful and the recipient has since been discharged from hospital in good condition. The new liver is functioning very well.

leveroperatie01-grTransplant surgeon Jeroen de Jonge of Erasmus MC performed the procedure with his colleague Piotr Domagala and transplant surgeon Volkert Huurman from the LUMC. He says "It is fascinating that an organ that was initially rejected for use by all centers for good reasons, can now, after a thorough test, still be used to save a patient's life. For me this shows the great importance of developing new organ perfusion techniques to save organs."

The extra organs that become available come mainly from donors who have died after circulatory arrest, rather than from brain-dead donors. "An increasing number of donors have died after circulatory arrest, but because of a lack of oxygen we often have to reject donor organs, in particular livers. NRP could help reduce the growing shortage of donor organs by tapping into a new resource. The actual function of organs that previously did not meet the criteria and were rejected can now be assessed, and means that they may still be eligible for transplantation", says Huurman.

Waiting list for donor organs
About one in five patients on the waiting list for an organ transplant currently die before an organ is available. The regional organ perfusion technique could make it possible to perform 30 additional liver and pancreas transplantations per year in the future. NRP will, of course, only be performed on people who have consented to organ donation. The results of NRP will be evaluated after two years and if these are positive the method can be extended to other types of donors and other regions of the Netherlands.

The project runs in the West Organ Donation region, is a collaboration between the LUMC, Erasmus MC and the Dutch Transplant Society, and is funded by the Ministry of Health, Welfare and Sport (VWS). 

Date published: 31 October 2018.

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