*Purpose: Rapid, effective in-situ cold perfusion of the abdominal organs in the setting of donation after circulatory death (DCD) is a critical surgical task to minimize warm ischemia time (WIT) and thus promote allograft viability and utilization. A modified aortic cannula was constructed as a technical improvement to permit rapid endovascular control of the thoracic aorta, without surgical exposure, upon start of cold perfusion and was trialed for proof of concept.

*Methods: In 22 consecutive DCD cases, prototype regional aortic perfusion cannulas (RAPC) were prepared prior to extubation using a 24 Fr tapered polymer cannula through which a 7 Fr catheter tipped with an inflatable distal balloon (30cc volume capacity) could be rapidly deployed upon aortic cannulation. In 15 cases, the RAPC was inserted into the distal aorta, retro-grade aortic cold perfusion initiated and occlusion balloon deployed in the descending thoracic aorta. Effluent was vented through the distal inferior vena cava (IVC) and organs topically cooled and procured through laparotomy incision alone. In one donor with two prior abdominal surgeries, the RAPC was inserted into the thoracic aorta via sternotomy, ante-grade cold perfusion initiated and catheter balloon deployed in the distal abdominal aorta. Effluent was vented from the suprahepatic IVC and paramedian laparotomy performed with limited adhesiolysis for topical cooling and kidney procurement. All recovered organs exhibited prompt back table flush.

*Results: 16 of 22 donors expired (73%) from which 30 kidneys, 1 liver and 1 pancreas were procured and transplanted. An additional 2 kidneys from 1 donor (KDPI=98) were discarded for biopsy findings. The liver underwent both in-situ and back table portal flush. Donor characteristics included: mean age of 50, Cr of 1.02+/-0.58, KDPI of 51.3+/-27.4 and BMI of 28+/-5.6. Overall, time from incision to cross clamp was 1.75+/-0.62 min and WIT was 25.5+/-15min. Aortic balloon occlusion was rapid (within 10 sec.) and effective in all cases. 6 kidneys were biopsied and 26 machine perfused with resistive indices at 30 min of 0.24+/-0.12. All transplanted organs functioned except for 1 kidney due to technical loss.

*Conclusions: Pilot experience with the novel RAPC device has demonstrated effectiveness in facilitating rapid in-situ cold perfusion to limit WIT of abdominal organs in the DCD setting without need for sternotomy or surgical control of the proximal aorta. It also offers potential utility for rapid core cooling of abdominal organs by ante-grade flush in the setting of prior abdominal surgery to permit unhurried surgical exposure of the peritoneal cavity and successful organ utilization.

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