In a landmark medical achievement, physicians at HCMCT Manipal Hospital, Dwarka, New Delhi, successfully carried out a post-mortem organ preservation procedure the first of its kind in Asia. Through the use of an extracorporeal membrane oxygenation (ECMO) machine and the technique called normothermic regional perfusion (NRP), the team restored blood flow soon after the heart had stopped, making the organs viable for donation.
A 55-year-old woman, Geeta Chawla who had advanced motor neuron disease (MND), was admitted on November 5 with severe breathing difficulties; her condition worsened and the family opted not to initiate life support. She was declared dead on November 6 at 8:43 pm.
After circulatory death (i.e., heart stopped and ECG flat), the team initiated NRP: they used an ECMO machine to restart circulation to the abdominal organs (liver and kidneys) while isolating cerebral circulation (to respect brain-death boundaries) so that only intended organs were perfused.
The revived organs were retrieved and allocated via the National Organ and Tissue Transplant Organisation (NOTTO) for transplantation: the liver went to a 48-year-old male at Institute of Liver & Biliary Sciences (ILBS), and the kidneys to two male recipients (aged 63 and 58) at Max Hospital Saket. Additionally, corneas and skin tissues from the donor were also used. Hospital officials have indicated that this is the first time in Asia a circulation-after-death organ retrieval has been performed using regional perfusion.
Traditionally, organ donation in India and many countries is performed when a donor is declared brain-dead (i.e., irreversible cessation of all brain activity) while the heart is still beating. In such cases, organs receive blood flow until retrieval, reducing damage. In Donation after Circulatory Death (DCD), the heart has stopped and circulation has ceased, meaning organs begin to suffer ischemia (lack of oxygenated blood). Time is critical, therefore circulation has to be artificially started.
Normothermic: The organs are perfused at near-normal body temperature, rather than cold preservation.
Regional Perfusion: Circulation is re-established only to specific regions (e.g., abdominal organs) while excluding the brain, to ensure that restoration of flow does not conflict with the legal/death determination of brain or circulatory death.
ECMO (Extracorporeal Membrane Oxygenation): A machine that takes over the function of heart and lungs, it pumps and oxygenates blood outside the body, then returns it. In this scenario, ECMO is used post-mortem to pump oxygenated blood into the donor’s organs to preserve viability for transplantation.
By applying NRP via ECMO in DCD cases, organs that would otherwise deteriorate too quickly after circulatory death can be preserved long enough for safe retrieval and transplantation. This potentially expands the donor pool beyond the traditional brain-death donor population. As noted, India ranked eighth globally for organ donations after brain death in 2024 (1,128 donors) but DCD remains under-utilised.
Reference:
1. Alamouti-Fard, Mehrdad, Michel S. M. Gaisl, Kristin Haering, Farhad Rasouli, Daniel Schiffer, Ulrich H. Bratton, and Jan-Peter Sauter. 2022. “Normothermic Regional Perfusion Is an Emerging Cost-Effective Alternative in Donation After Circulatory Death (DCD) in Heart Transplantation.” Journal of Cardiothoracic Surgery 17 (1): 230. https://pmc.ncbi.nlm.nih.gov/articles/PMC9246458/
(Rh/TL/MSM)