ArticleAmerican journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons2020
Maintaining the permanence principle for death during in situ normothermic regional perfusion for donation after circulatory death organ recovery: A United Kingdom and Canadian proposal.
Article in American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07423936 (Multimodal NeurOmonitoring During NormOthermic Regional PerFusion for Organ Donors Determined Dead by CircuLatory Criteria fOllowing Withdrawal of Life Sustaining Measures), which is not on this map. Cited by 53 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Multimodal NeurOmonitoring During NormOthermic Regional PerFusion for Organ Donors Determined Dead by CircuLatory Criteria fOllowing Withdrawal of Life Sustaining Measures (NONOFLOW): A Proof-of-Concept Study
Who cites it
53 citing papers in PubMed, 1 synthesis or guideline pooled it, 163 citations in OpenAlex.
- Outcomes of donation after circulatory death heart transplant using normothermic regional perfusion: a systematic review and meta-analysis.Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs · 2026Pooled it
- Article
- Death determination at the bedside: clinical judgement beyond criteria.Critical care (London, England) · 2026Review
- Reperfusion Strategies in Donation After Circulatory Death Heart Transplantation: An Up-to-Date Narrative Review.Journal of clinical medicine · 2026Review
- Organ donation after ECPR: ethical challenges and clinical implications.Critical care (London, England) · 2026Review
- Patient perspectives on the ethics and acceptability of perfusion techniques for organ transplantation: a qualitative study.Transplant international : official journal of the European Society for Organ Transplantation · 2026Article
- Optimizing Temperature in Ex Situ Heart Perfusion: A Comparative Review of Traditional and Novel Methods in Heart Transplantation.Journal of cardiovascular development and disease · 2026Review
- Abdominal normothermic regional perfusion in controlled DCD: toward a multidisciplinary model of organ resuscitation.Frontiers in transplantation · 2026Article
- Normothermic regional perfusion (NRP) use in controlled donation after circulatory determination of death (cDCDD): results of the European Society for Organ Transplantation Bucharest consensus conference.Transplant international : official journal of the European Society for Organ Transplantation · 2026Article
- Overcoming barriers and expanding opportunities in liver transplantation in Mexico.World journal of transplantation · 2025Review
- Early and Mid-Term Results of Solid Organ Transplantation After Circulatory Death: A 4-Year Single Centre Experience.Medicina (Kaunas, Lithuania) · 2025Article
- The Necessity of Brain Blood Flow Testing in Thoracoabdominal Normothermic Regional Perfusion.Transplantation · 2025Article
- Barriers and solutions for introducing donation after circulatory death (DCD) in Japan.Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs · 2025Review
- Update on Organ Allocation and Liver Transplantation.Gastroenterology & hepatology · 2025Article
- Article
- Challenges and opportunities in organ donation after circulatory death.Journal of internal medicine · 2025Review
- The anesthetist perspective: optimization of cardiac allograft from withdrawal of life support to reperfusion in the controlled donation after circulatory death.Annals of cardiothoracic surgery · 2025Article
- Thoracoabdominal normothermic regional perfusion-approaches to arch vessels and options of cannulation allowing donation after circulatory death multi-organ perfusion and procurement.Annals of cardiothoracic surgery · 2025Article
- Heart Transplantation and Donation After Circulatory Death in Children. A Review of the Technological, Logistical and Ethical Framework.Transplant international : official journal of the European Society for Organ Transplantation · 2025Review
- A scoping review of the legal and ethical challenges with the use of normothermic regional perfusion in controlled donation after circulatory determination of death from 2005 to 2023.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2025Article
Corrections and comments
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Authors and funding
23 authors at 15 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
There is international variability in the determination of death. Death in donation after circulatory death (DCD) can be defined by the permanent cessation of brain circulation. Post-mortem interventions that restore brain perfusion should be prohibited as they invalidate the diagnosis of death. Retrieval teams should develop protocols that ensure the continued absence of brain perfusion during DCD organ recovery. In situ normothermic regional perfusion (NRP) or restarting the heart in the donor's body may interrupt the permanent cessation of brain perfusion because, theoretically, collateral circulations may restore it. We propose refinements to current protocols to monitor and exclude brain reperfusion during in situ NRP. In abdominal NRP, complete occlusion of the descending aorta prevents brain perfusion in most cases. Inserting a cannula in the ascending aorta identifies inadequate occlusion of the descending aorta or any collateral flow and diverts flow away from the brain. In thoracoabdominal NRP opening the aortic arch vessels to atmosphere allows collateral flow to be diverted away from the brain, maintaining the permanence standard for death and respecting the dead donor rule. We propose that these hypotheses are correct when using techniques that simultaneously occlude the descending aorta and open the aortic arch vessels to atmosphere.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.