New Advanced Procedure at the University of Maryland Medical Center Results in Lifesaving Liver Transplant

October 01, 2024 

A liver transplant recipient from Maryland's Eastern Shore says he's glad to be alive after the transplantation team at the University of Maryland Medical Center (UMMC) used an innovative organ retrieval procedure to recover a liver from a deceased organ donor. This transplant marks the first time the groundbreaking procedure, called abdominal normothermic regional perfusion (A-NRP), has been used in Maryland and the National Capital Region.

A-NRP provides oxygenated blood flow to abdominal organs after a patient has been declared dead. Transplant specialists say it has the potential to reduce complications and improve outcomes for transplant recipients. A-NRP would also increase the number of viable organs for transplant, helping more people on the wait list.

NRP is a recent and significant advancement in organ preservation, which minimizes damage to the organ while providing time to test the quality of the organ," said Daniel G. Maluf, MD, a transplant surgeon at the University of Maryland Medical Center (UMMC) and Professor of Surgery at the University of Maryland School of Medicine.

"NRP is logistically complex and requires a multidisciplinary team with expertise in organ procurement, perfusion technology and transplantation surgery," said Dr. Maluf, who was part of the UMMC A-NRP team of surgeons, including Josue Alvarez-Casas, MD, Chandra Bhati, MD, Raphael Meier, MD, Saad Malik, MD, Jordan Pyda, MD, and the perfusion group, led by Brian McCormick, CCP. "It must be conducted in compliance with legal and ethical guidelines, including that the declaration of death is unequivocal and consent for organ donation is confirmed with the family."

Edward Robbins, 51, who received this liver transplant in July, says his care team estimated that without a transplant, he had 18 months to two years to live after multiple liver infections and various measures of liver function showed he was in liver failure. His transplant changed everything. "The transplant—it's a miracle, in my eyes," said Robbins.

Robbins was placed on the UMMC transplant wait list in April, and later went to another area hospital to correct a blood flow blockage to his liver, thinking he might get a transplant next year. Instead, he woke up several days later at UMMC after an emergency transfer for a transplant. "My friends were pretty scared. When I woke up, I saw I had been unconscious for so long that I missed 100 calls from friends asking how I was doing. That's when I learned I was getting a new liver," said Robbins.

More than 9,000 people in the United States are waiting for a liver transplant; up to 20 percent of those patients do not survive and die waiting. While a living donor can donate a kidney or part of their liver, more than 93 percent of liver transplants in the U.S. come from deceased donors.

At UMMC, the flagship academic hospital of the University of Maryland Medical System, living donor liver transplantation is considered for most patients awaiting a liver transplant, typically resulting in an earlier transplant, less chance of organ rejection and faster recovery. In 2023, UMMC performed 91 liver transplants, eight from living donors and 83 from deceased donors. If a patient on the wait list does not have a family member, loved one or other person willing or able to donate a liver, a deceased donor becomes the only option.

Recent data shows an overall increase in the use of deceased donor organs, especially from donors whose organs previously would not have met transplant criteria, such as those who died following circulatory death, rather than brain death. In 2023, 36 percent of total donors donated after circulatory death, a 40.7 percent increase over the past three years, according to the Organ Procurement & Transplantation Network (OPTN).

In donation after circulatory death (DCD), the death of the patient is confirmed after circulation and respiratory functions have stopped and a qualified medical practitioner who is not part of the transplant team pronounces the death.

The A-NRP technique is used only for DCD donors. After a brief waiting period following the declaration of circulatory death, surgeons confine perfusion to the abdomen by clamping key blood vessels. Oxygenated blood flow is then re-established to the abdominal organs using thin tubes and a perfusion circuit. Blood is kept at "normothermic" or normal body temperature (37°C or 98.6°F), closely mimicking physiological conditions. This circuit helps recover cellular metabolism and provides information to evaluate the viability of the donor organs in real time.

A-NRP is an alternative to the most common method to procure DCD organs. Recent research data suggests A-NRP may reduce rates of complications and bile duct damage in the donor liver compared to traditional DCD recovery.

The UMMC team partnered with Infinite Legacy, the local organ procurement organization, which worked closely with the donor family to guide them through the process and provide compassionate care. UMMC and Infinite Legacy together developed a protocol that supports the A-NRP approach.

“Organ donors make second chances possible,” said Charlie Alexander, President and Chief Executive Officer, Infinite Legacy. “At Infinite Legacy, it is our privilege to honor the generosity of donors and to work with partners such as UMMC who continue to save lives in innovative ways.”

Robbins came home a week after his transplant. Since then, his liver scores are improving and his surgical incisions are healing normally. He says he is grateful for his new post-transplant life and is especially thankful to his donor and their family who made the decision to give the gift of life.

As for A-NRP and the treatment he received from the nurses, doctors and other team members at UMMC, "I am very excited to be in a position to hopefully give back to this amazing facility and bring attention and the support needed to make this process more available to save so many more lives." Robbins adds, "If this new technique can save even a fraction of those people who are waiting for an organ transplant, then this is truly amazing."