Abstract
BACKGROUND: Normothermic regional perfusion (NRP) is gaining rapid popularity in adult donation after circulatory death (DCD) to increase organ utilization and improve outcomes. However, literature is lacking for the pediatric population. We therefore present the youngest DCD donor in the United States from whom a liver was recovered with NRP and subsequently transplanted. METHODS: The donor was a 5-year-old male who underwent thoraco-abdominal NRP for kidney and liver procurement. In total, 72 min passed from the withdrawal of life-sustaining treatment to the start of NRP, resulting in 10 min of functional warm ischemia time. The donor was perfused for 80 min, with lactate levels decreasing from 8.29 at the start of perfusion to 5.40 mmol/L at the end of perfusion. The procured graft weighed 480 g and was subsequently transplanted in an adult female recipient with decompensated cirrhosis due to alcohol-associated liver disease. RESULTS: The liver was successfully utilized and functioned immediately with no graft-specific complications. The patient was discharged on postoperative day 39. CONCLUSIONS: This case demonstrates that NRP can be applied effectively in small pediatric donors, yielding excellent early graft function. Our experience adds to the emerging literature on pediatric NRP. We conclude that broader adoption of NRP could help increase the donor pool and ease the strain on the pediatric waiting list.