Abstract: Aim The use of abdominal normothermic regional perfusion (nRP) and premortem interventions in controlled donation after circulatory death (cDCD) may represent a significant advance to increase the number and quality of grafts recovered in cDCD. The main limitation for the widespread acceptance of nRP in cDCD is the concerns of restoring circulation to the brain once death has been declared should the thoracic aorta not be adequately blocked. Methods We describe and validate a specific methodology to ensure an appropriate blocking of the thoracic aorta in a multicenter study using this technique. Results A total of 78 procedures with premortem cannulation and abdominal nRP were performed in four different hospitals. No case of heart or brain resuscitation was observed after nRP Conclusion The use of premortem interventions before nRP and the aortic occlusion balloon may increase the number of grafts recovered in cDCD. Our proposed methodology avoids the ethical problem of resuscitation by guaranteeing that circulation to the heart and brain is not restored after nRP.

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