Medstar Georgetown University Hospital, United States
Background/Case Studies: The use of universal group O Rh(D) positive Red Blood Cells (RBC) for normothermic machine perfusion to support organ transplantation has been previously well described. Two years ago our transfusion service began to support ex-situ liver perfusion with ABO matched RBC and ABO compatible plasma via a “two sample” ABO blood group verification process. The original intent was to conserve group O units, but later when plasma was required as a source of plasminogen with use of tissue plasminogen activator as a mitigation strategy for vascular microthrombi in some circulatory death donor (DCD) livers it became essential to provide ABO specific components.
Study
Design/Methods: Organs are registered via their United Network Organ for Sharing (UNOS) identification numbers in the hospital information system (HIS). The transplant team enters orders for 3 units of Red Blood Cells (RBC), and for certain DCD livers, 250 cc of Plasma. The transplant coordinator emails a portable document format (PDF) record of the donor hospital ABO/Rh test results identified by the UNOS ID which are entered in the blood bank information system as the initial ABO/Rh result. An aliquot from a blood sample submitted to the HLA lab is tested as the second ABO verification sample. RBCs are computer-crossmatched and assigned to a HIS-connected blood storage device in the operating room. 1-2 units of plasma are issued in a portable cooler. Total units issued characterized by ABO and Rh blood group were retrospectively calculated.
Results/Findings: From 5/2023 to 4/2025 176 livers were perfused. Plasma units were requested for 76. An additional RBC was requested for one liver and an additional 3 RBC for one liver. ABO/Rh group totals are provided in table 1. 228 group O RBC units were conserved. No discrepancies were observed between the ABO/Rh results provided in the emailed PDF and the locally tested blood specimen test results.
Conclusions: It is feasible to provide ABO specific RBC units for organ perfusion. Donor ABO information provided by UNOS should be adequate for issuing ABO matched blood components.
