Abstract / Summary
ABSTRACT Controlled donation after circulatory death (cDCD) with thoracoabdominal normothermic regional perfusion (TA‐NRP) has emerged worldwide as a strategy to expand the heart donor pool. In Italy, however, its implementation is constrained by a particularly restrictive setting, shaped by the mandatory 20‐min asystolic no‐touch period and by the absence of cardiac surgery units in most donor hospitals. Against this backdrop, the Emilia‐Romagna Regional Transplant Network developed a mobile DCD Heart Team capable of performing TA‐NRP in peripheral hospitals. We report a case series of 19 cDCD donors managed with TA‐NRP within a regional program based at a high‐volume tertiary university hospital, all with prolonged functional warm ischemic time (FWIT). Seventeen hearts (89.5%) were successfully procured and transplanted, with a median FWIT of 41 (37.5–52) minutes, and serial transesophageal echocardiography and hemodynamic assessment supported real‐time monitoring of myocardial recovery. No recipient required postcardiotomy veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO), and no primary graft dysfunction or 30‐day mortality were observed. These findings support TA‐NRP heart procurement as a feasible and clinically effective procedure—even in centers without onsite cardiac surgery—when a dedicated mobile heart team is available, thereby encouraging the broad adoption of cDCD heart procurement within the Italian legislative and organizational context.