AUTHOR=Hunt Fiona , Johnston Chris J. C. , Coutts Lesley , Sherif Ahmed E. , Farwell Lynsey , Stutchfield Ben M. , Sewpaul Avi , Sutherland Andrew , Babu Benoy I. , Currie Ian S. , Oniscu Gabriel C. 

TITLE=From Haphazard to a Sustainable Normothermic Regional Perfusion Service: A Blueprint for the Introduction of Novel Perfusion Technologies

JOURNAL=Transplant International

VOLUME=Volume 35 - 2022

YEAR=2022

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2022.10493

DOI=10.3389/ti.2022.10493

ISSN=1432-2277

ABSTRACT=Normothermic Regional Perfusion (NRP) has shown encouraging clinical results. However, translation from an experimental to routine procedure poses several challenges. Herein we describe a model that led to the implementation of NRP into standard clinical practice in our centre following an iterative process of refinement incorporating training, staffing and operative techniques.   A novel role of Advanced Perfusion and Organ Preservation Specialist was created to lead and coordinate the implementation of NRP. A four-step process (recruitment, education and training, implementation and review for evaluation) included all stakeholders in the donation and retrieval process. A bespoke competency-based training and education programme supported by practical hands-on sessions and simulation for troubleshooting was developed. A weekly meeting for feedback and routine team de-brief was implemented to streamline service delivery. Using this approach we achieved a four-fold increase in trained surgical staff and a 6-fold increase in competent senior organ preservation practitioners in 12 months, covering 93% of the retrieval calls. We now routinely provide NRP throughout the UK and attended 186 NRP retrievals from which 225 kidneys, 26 pancreases and 61 livers have been transplanted, including 5 that were initially declined by all UK transplant centres. The 61 DCD(NRP) liver transplants undertaken exhibited no primary non-function or ischaemic cholangiopathy with up to eight years of follow-up. This approach also enabled successful implementation of ex situ normothermic liver perfusion which together with NRP contributed to 37.5% of liver transplant activity in 2021. Perfusion technologies (in situ and ex situ) are now supported by a team of four full-time Advanced Perfusion and Organ Preservation Specialists. The introduction of NRP into routine clinical practice presents significant challenges. Developing a specific role of Advanced Perfusion and Organ Preservation Specialist has been key to delivering a sustainable service and facilitated the seamless implementation of other novel perfusion technologies.