Karolinska performs Sweden’s first liver transplant from a donor after circulatory death

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Karolinska is the first hospital in Sweden to have performed a liver transplant from a donor following circulatory death. The procedure was made possible by a new technique called Normoterm Regional Perfusion (NRP), which Karolinska is the first hospital in the Nordic region to have introduced.

Donation following circulatory death means that an organ is removed after the death of the donor patient in intensive care as a result of the heart stopping and the cessation of breathing. This was introduced in Sweden in 2018, and makes it possible for more people to donate their organs for life-saving transplants.

It has previously only been possible to transplant kidneys and lungs after circulatory death. However, by applying the new process of warm blood perfusion (also known as Normoterm Regional Perfusion, NRP), it has now become possible for liver transplants to be performed after circulatory death.

Unique partnership behind the procedure
Sweden's first liver transplant from a donor after circulatory death using NRP has now been performed at Karolinska. The procedure was made possible by a unique partnership between PMI, ECMO centrum, Regionalt donationscentrum and Transplantation.

The NRP machine
The machine for Normoterm Regional Perfusion (NRP).
"The donation enabled the transplanting of two kidneys and one liver. The results were very good – all three recipients are doing well, and all the donated organs are functioning well", says Carl Jorns, section manager for liver transplants.

NRP improves the organ quality
Liver transplants after circulatory death have previously been associated with poor results, because the liver deteriorates within just a few minutes once the blood supply has been cut off. The new NRP technique enables the abdominal organ to be saved by recreating the blood circulation for around two hours, followed by an operation. This improves the quality of the organ. Another advantage is that the functioning of the organ can be assessed in conjunction with the performance of the operation, and more time can be devoted to performing the organ donation. NRP results in both fewer complications and better survival rates following the liver transplant.

"We believe that this technique will make it possible to perform 10-20 per cent more liver transplants each year in Sweden. This will enable us to reduce both the waiting time for the organ and the deaths of those on the waiting list", says Carl Jorns.

Studies have also shown similarly good results for kidney and pancreas transplants.

The project is being conducted within national highly specialised care for liver transplants at Karolinska University Hospital and Sahlgrenska University Hospital.

CIRCULATORY DEATH

Donation following circulatory death means that an organ is removed following the death of the donor patient in intensive care as a result of the heart stopping and the cessation of breathing. The method makes it possible for more people to donate their organs. The donation method is well-established in other countries, and was introduced in Sweden in 2018.

Donations were previously only possible when the patient had experienced total brain death while receiving intensive care.