First En-Bloc Heart and Lung Rapid Recovery combined with Abdominal Normothermic Regional Perfusion Donation After Circulatory Death Procurement

Objective: To describe a novel approach to DCD heart and lung procurement combining rapid en-bloc recovery with abdominal normothermic regional perfusion (A-NRP) for liver and kidney, addressing ethical concerns associated with thoracoabdominal NRP (TA-NRP).

Methods: We present a case report of a DCD donor where the heart and lungs were procured for separate recipients using a direct, rapid recovery technique. A-NRP was initiated for abdominal organ recovery, while the heart was reanimated with ex situ machine perfusion (TransMedics, Organ Care System) and the lungs were preserved using a BaroGuard system. Procurement techniques, ischemic times, and recipient outcomes are reported.

Results: The heart and lungs were successfully procured en-bloc and separated on the back table. For meticulous bleeding control, inferior vena cava and thoracic aorta were clamped, Superior vena cava, neck vessels and azygos vein were ligated, ensuring no compromise to the A-NRP circuit. The heart recipient underwent a beating heart transplant; total bypass time was 100 minutes, with a cross-clamp time of 33 minutes and 273 minutes on the TransMedics OCS. The heart recipient was discharged home on postoperative day 19 with normal biventricular function (LVEF 55%). The lung recipient underwent bilateral transplantation with a total bypass time of 103 minutes and total ischemic times of 538 and 576 minutes. This patient was extubated on postoperative day 1 and discharged home on postoperative day 12 with excellent gas exchange. A-NRP was maintained for 73 minutes with stable flow rates and favorable lactate trends, enabling successful liver and kidney procurement.

Conclusion: This case demonstrates the feasibility and strategic value of combining rapid en-bloc heart and lung recovery with A-NRP for abdominal organs in DCD donation, offering a potential solution for institutions with ethical concerns regarding TA-NRP. The described dual procurement technique enables effective recovery of both thoracic and abdominal organs, but meticulous technique and communication between procurement teams are crucial for successful outcomes.

Chawannuch Ruaengsri (1), Yasuhiro Shudo (2), Marc Leon (2), Albert Pedroza (3), Katherine Verdi (4), Manuel Quiroz-Flores (2), Masafumi Shibata (5), Glenn Pelletier (6), William Hiesinger (7), Brandon Guenthart (8), Y. Joseph Woo (2), John MacArthur (9), (1) Stanford University, Menlo Park, CA, (2) Stanford University, Stanford, CA, (3) Stanford University, Santa Clara, CA, (4) N/A, CA, (5) Stanford University, Sunnyvale, CA, (6) N/A, Villanova, PA, (7) Stanford University School of Medicine, STANFORD, CA, (8) Stanford University Medical Center, Stanford, CA, (9) Stanford Hospital and Clinics, Menlo Park, CA

Chawannuch Ruaengsri

Abstract Presenter

Dr. Chawannuch Ruaengsri is a Clinical Assistant Professor in the Division of Cardiothoracic Surgery at Stanford University and serves as Director of the Transplant Procurement Surgery Program. She earned her MD from Mahidol University in Bangkok, Thailand, and completed residency and fellowship training in adult cardiac surgery at Mahidol University. She further specialized in atrial fibrillation surgery as a postdoctoral fellow at Washington University in St. Louis, followed by extensive training in mechanical circulatory support and minimally invasive adult cardiac surgery at Barnes Jewish Hospital, Washington University in St. Louis and Emory University. Since joining Stanford in 2021, Dr. Ruaengsri has contributed significantly to developing novel techniques for heart and lung transplantation, including the first beating-heart transplant from a circulatory death donor at Stanford. Her research focuses on organ preservation, transplant innovation, and expanding donor pools through advanced surgical approaches.