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The use of third-party packed red blood cells during ex situ normothermic machine perfusion of organs for transplantation: Underappreciated complexities?

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Chris J Callaghan, Benedict L Phillips, Theodora Foukaneli, Susan Robinson, Christopher J E Watson

Bibliographical note

Funding Information: We would like to acknowledge and thank Pankaj Chandak, Tim Maggs, Charlene Furtado, and other colleagues within the Guy?s and St Thomas? NHS Foundation Trust transplant and transfusion teams for their advice and support with the initiation and development of the Guy?s Hospital kidney ex situ NMP program. The University of Cambridge has received salary support in respect of CJEW from the NHS in the East of England through the Clinical Academic Reserve. The views expressed are those of the authors and not necessarily those of the NHS, NHSBT, or Department of Health. Publisher Copyright: © 2020 The American Society of Transplantation and the American Society of Transplant Surgeons Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors


Ex situ normothermic machine perfusion (NMP) is being used increasingly in the assessment of higher risk deceased donor organs and to facilitate prolonged organ storage. Third-party packed red blood cells (pRBCs) are often used as an oxygen carrier in the perfusate of ex situ NMP. Despite the increasing interest in NMP, comparatively little attention has been paid to the appropriate selection of pRBCs. This includes the choice of ABO blood group and Rhesus D status, the need for special requirements for selected recipients, and the necessity for traceability of blood components. Flushing organs with cold preservation solution after NMP removes the overwhelming majority of third-party allogeneic pRBCs, but residual pRBCs within the organ may have biologically relevant effects following implantation as they enter the recipient's circulation. This review considers these issues, and suggests that national transplant and blood transfusion agencies work together to develop a co-ordinated approach within each country. This is especially important given the possibility of organ re-allocation between centers after ex situ NMP, and the ongoing development of organ perfusion hubs.

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