Background: Heart transplantation is an effective service offering the best recovery in both quality and quantity of life to those trapped by refractory, severe heart failure. However, transplantation is limited by donor organ availability. The reintroduction of non-heart beating heart donation (DCD donation) in 2014 offers an uplift in transplant activity by 30%. The DCD donor heart is ischaemic and requires reperfusion. This may occur outside the donor鈥檚 body ( ex-situ perfusion ) or within it (thoraco-abdominal normothermic perfusion: taNRP59 taNRP transplants have been included from  four major transplant centres worldwide including the UK, USA and Belgium.

Findings: The mean functional total ischaemic time (FTIT) was 16路8minutes. Survival was excellent in this small clinical experience. The median donor heart related survival time was 430days and mean survival 800days. Thirty-day survival (n =59 ), one-year survival (n =39 ) and five-year survival (n =10 ) in terms of donor heart related survival 100% falling to 98路3% when accounting for the intra-operative death following acute aortic dissection at the time of transplantation.

Interpretation: The survival rates of taNRP are superior to both DBD (donation after brain death) and direct procurement DCD donors, where the one-year survival is roughly 90%. The difference may in part be related to a shorter FTIT or through a possible selection bias. Therefore, taNRP offers an exciting method of organ preservation and procurement. In addition, it offers a tool with which we can increase the total number of transplants being performed and minimise waiting list mortality.

Funding Information: None.

Declaration of Interests: None of the authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.

Ethics Approval Statement: Approval was given by the NRES Committee East of England - Cambridge East, 05/Q0104/111.