Document Type

Article

Publication Date

5-5-2025

Abstract

Background: Donation after Circulatory Death (DCD) was the original mode of transplantation (e.g., first lung transplant in 1963 and first heart transplant in 1967) (1,2) but was largely abandoned post-1968 following the Harvard brain-death criteria (3). Recently, Normothermic Regional Perfusion (NRP) has renewed interest in DCD by mitigating warm ischemic injury. However, Certified Clinical Perfusionists (CCPs), who manage the extracorporeal circuits essential for NRP, remain largely overlooked or underrepresented in protocols and literature, even though they are, according to the American Board of Cardiovascular Perfusion (ABCP), the only professionals “formally educated and trained in adult and pediatric extracorporeal technology” (4).

Methods: This scoping review was conducted following PRISMA-ScR guidelines. PubMed and CINAHL were searched (1990–2025) for peer-reviewed articles referencing NRP in DCD donors and mentioning the term “perfusionist” or “Certified Clinical Perfusionist.” Articles that met eligibility criteria (English language, full text, explicit mention of perfusion staff) were included. Data was extracted to identify themes regarding the perfusionist’s role and standardized protocols.

Results: A total of 75 articles were identified. After screening and eligibility assessment, 10 articles were included for full review. Results indicated that perfusionists are integral to circuit setup, oxygenation monitoring, and warm ischemia reduction through precise flow management and anticoagulation oversight. However, few studies provided formal guidelines clarifying the CCP’s standardized responsibilities in NRP.

Conclusions: Despite the crucial function CCPs fulfill in preventing ischemic damage during DCD-NRP, they are not consistently highlighted in guidelines or institutional policies. Greater inclusion of perfusionists as key stakeholders is called for, along with standardized credentialing requirements and explicit role definitions to improve outcomes in NRP.

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