Machine Perfusion in abdominal organ transplantation

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* 1. What is your gender?

Female

Male

Other (specify)

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* 2. In what country do you work?

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* 3. What is your age?

18-25

26-35

36-45

46-55

56-65

> 65

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* 4. Hospital / Unit

University Hospital

Large City / regional Hospital

Other Type of Hospital

Covering more than one region (coordinator, industry,...)

Other (please specify type of hospital)

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* 5. Staff Role

Transplant Surgeon

Physician

Anesthetist

Intensivist

Intensive Care Nurse

Theatre Nurse

Transplant Coordinator - Donor

Transplant Coordinator - Recipient

Other (please specify)

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* 6. Employment Position

Head of Department / Team Leader

Consultant

Registrar

Fellow

Nurse

Other (please specify)

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* 7. How many years of clinical experience do you have ?

> 2 - 5

> 5 - 10

> 10 - 20

> 20

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* 8. How many transplant procedures are done annually in your centre?

0 - 20

21 - 50

51 - 100

101 - 150

151 - 200

201 - 300

> 300

Not applicable

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* 9. Which organs do you and your team deal with ?

Liver

Kidney

Pancreas

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* 10. How many deceased LIVER transplant procedures are done annually in your centre?

0 - 20

21 - 50

51 - 100

101 - 150

151 - 200

201 - 300

> 300

Not applicable

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* 11. How many deceased KIDNEY transplant procedures are done annually in your centre?

0 - 20

21 - 50

51 - 100

101 - 150

151 - 200

201 - 300

> 300

Not applicable

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* 12. How many pancreas transplantations are done annually in your centre ?

0 - 5

6 - 10

11 - 15

16 - 20

21 - 50

> 50

Not applicable

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* 13. Do you have a donation after circulatory death (DCD) transplant program in your centre ?

Yes

I don`t know

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* 14. Are you familiar with machine perfusion technology ?

Yes

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* 15. How experienced or involved have you been in machine perfusion ?

Have seen it before

Have supported the perfusion team before

Actively involved as a member of the perfusion team or study team

I`m aware of this technology, but have never seen it

I`m not aware of machine perfusion technology

Perfusion team leader

I‘m working for a machine perfusion company

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* 16. Do you have a specific clinical/scientific committee in your centre or department, who decides what preservation or perfusion strategy to implement ?

Yes

Planned to be implemented

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* 17. What perfusion techniques or strategies are routinely performed in your centre (please select more than one answer if appropriate) ?

Normothermic Regionel Perfusion (NRP)

Hypothermic Oxygenated Perfusion (HMP, HMP-O2, HOPE, D-HOPE)

Normothermic Machine Perfusion (NMP)

Controlled Oxygenated Rewarming (COR)

Oxygen Persufflation

Ischemia Free Organ Transplantation (IFOT)

None

Other (please specify)

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* 18. Did your centre participate or have you recently participated in a multicentre clinical trial on machine perfusion ?

Yes

Planned

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* 19. Did your centre initiate or lead a clinical trial in machine perfusion ?

Yes - in house

Yes - national multicentre

Yes - international - multicentre

Planned

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* 20. Are you aware of a person or a group in your centre, who performs experimental research on machine perfusion ?

Yes - there is experimental research in my centre (laboratory)

I don`t know

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* 21. If there is experimental research, please specify accordingly.

Experimental research with animals

Experimental research with discarded human LIVERS

Experimental research with discarded human KIDNEYS

Experimental research with discarded human LIVERS and KIDNEYS

Not applicable

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* 22. How many organs are declined in your institution annually? Please select percentage.

0 - 5 %

6 - 10 %

11 - 20 %

21 - 30 %

> 30 %

Not applicable

Other (please specify)

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* 23. What is the main reason to decline a Liver in your centre ?

Donor risk (e.g. age, medical risk, lab values,...)

Organ quality (macroscopy, perfusion quality during procurement, donor warm ischemia time, ...)

Recipient disease severity (medically unfit for procedure)

Logistical issues (e.g. ITU / Theatre capacity)

NONE-we are not doing liver transplantation in my centre

Not applicable

Other (please specify)

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* 24. What is the second main reason to decline a Liver in your centre ? (chose a different answer please)

Donor risk (e.g. age, medical risk, lab values,...)

Organ quality (e.g. macroscopy, perfusion quality during procurement, donor warm ischemia time,...)

Recipient disease severity (medically unfit for procedure)

Logistical issues (e.g. ITU / Theatre capacity)

NONE-we are not doing liver transplantation in my centre

Not applicable

Other (please specify)

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* 25. What is the main reason to decline a kidney in your centre ?

Donor risk (e.g. age, past medical history, hypertension, advanced KDPI / KDRI,...)

Organ quality (e.g. perfusion quality at procurement, biopsy, donor warm ischemia time,...)

Recipient disease severity / medical fitness

Logistical issues (e.g. ITU / theatre capacity)

NONE-we are not doing kidney transplantation in my centre

Not applicable

Other (please specify)

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* 26. What is the second main reason to decline a kidney in your centre ? Please select a different answer.

Donor risk (e.g. age, past medical history, hypertension, advanced KDPI / KDRI,...)

Organ quality (e.g. perfusion quality at procurement, biopsy, donor warm ischemia time,...)

Recipient disease severity / medical fitness

Logistical issues (e.g. ITU / theatre capacity)

NONE-we are not doing kidney transplantation in my centre

Not applicable

Other (please specify)

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* 27. What is your main expectation from new machine perfusion technology (or what would you want to be improved) – please select the most important one from the list.

Improve donor organ quality, reduce ischemia / reperfusion injury and prevent complications

Positive impact on logistical issues (e.g. bridge lack of ITU / Theatre capacity)

Easy to implement in clinical practice

Cost effective

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* 28. What is your second most important expectation from new machine perfusion technology (or what would you want to be improved) – please select a different one from the list.

Improve donor organ quality, reduce ischemia / reperfusion injury and prevent complications

Positive impact on logistical issues (e.g. bridge lack of ITU / Theatre capacity)

Easy to implement in clinical practice

Cost effective

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* 29. What would you consider as acceptable price for one perfusion device ?

0 - 20`000 Euro

> 20`000 - 50`000 Euro

> 50`000 - 80`000 Euro

> 80`000 - 120`000 Euro

> 120`000 - 150`000 Euro

> 150`000 Euro

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* 30. What would you consider as acceptable price for one disposable for organ perfusion (one organ perfusion)?

0 - 1`000 Euro

> 1`000 - 2`500 Euro

> 2`500 - 5`000 Euro

> 5`000 - 10`000 Euro

> 10`000 - 15´000 Euro

> 15`000 - 20`000 Euro

>20`000 - 30`000 Euro

> 30`000 Euro

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* 31. How should the perfusion device be financed ?

Direct payment of perfusion device

Loan of device with higher costs for the disposable

Rent

Rent to buy

Lease with option to buy

Other (please specify)

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* 32. Which entity should finance machine perfusion technology ?

Government or public national health system

Hospital

Hospital through recipient insurance

Privately financed by organ recipient

Regional or national transplantation society

Research Grant

Charity

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* 33. Considering the available research data do you think machine perfusion technology should be integrated into routine clinical practice with full comissioning ?

Yes

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* 34. Are there relevant limitations to implement machine perfusion technology in your country or centre ?

Yes

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* 35. Please select the main reason that precludes the implementation of machine perfusion in your centre.

Lack of knowledge on machine perfusion technology

I consider machine perfusion NOT superior to standard cold storage

Lack of staff in general

Lack of trained staff

No or limited funding opportunities

Logistical issues (e.g. device transport)

In my centre there is full support to implement machine perfusion technology.

Not applicable

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* 36. Do you think machine perfusion technology increases the utilisation of riskier organs ?

Yes

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* 37. Which organ perfusion modality would be the best to increase the utilisation of riskier organs ?

Normothermic regional perfusion (NRP)

Hypothermic machine perfusion (HMP)

Hypothermic oxygenated perfusion (additional perfusate oxygen, HOPE, D-HOPE, HMP-O2)

Normothermic machine perfusion (NMP)

None

Other (please specify)

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* 38. For what type of donors or LIVERS would you consider machine perfusion routinely ?

Any donor liver (e.g. any age or any quality, including any DBD, DCD, ...)

Advanced donor age

Livers from extended criteria donors (marginal grafts)

Livers from donation after circulatory death (DCD) donors

Steatotic livers

NONE-we are not doing liver transplantation in my centre

Other (please specify)

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* 39. For what type of donor KIDNEYS would you consider machine perfusion routinely ?

Any donor kidney (including standard criteria kidneys from brain death donors (DBD))

Advanced donor age

Kidneys from extended criteria donors

Kidneys from donation after circulatory death donors (DCD)

NONE-we are not doing kidney transplantation in my centre

Other (please specify)

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* 40. Which organ perfusion modality would be the best to protect liver recipients from ischemic cholangiopathy (incl. ITBL, NAS, IC) ?

Normothermic regional perfusion (NRP)

Hypothermic machine perfusion (HMP)

Hypothermic oxygenated perfusion (additional perfusate oxygen, HOPE, D-HOPE, HMP-O2)

Normothermic machine perfusion (NMP)

None

NONE-we are not doing liver transplantation in my centre

Other (please specify)

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* 41. Which organ perfusion modality would be the best to protect kidney recipients from rejection, delayed graft function and graft loss ?

Normothermic regional perfusion (NRP)

Hypothermic machine perfusion (HMP)

Hypothermic oxygenated perfusion (additional perfusate oxygen)

Normothermic machine perfusion (NMP)

None

NONE-we are not doing kidney transplantation in my centre

Other (please specify)

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* 42. Do you think normothermic perfusion is equally protective from reperfusion injury if applied instead of cold storage (with device transport) or after cold storage in the recipient centre ?

Yes

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* 43. At your centre do you base the decision to accept or decline an organ for transplantation on specific viability criteria assessed during machine perfusion ?

Yes

Not applicable

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* 44. Please state which main viability parameter / criteria you follow during organ machine perfusion.

Organ parameter (e.g. macroscopy, perfusion quality, soft organ, bile production,...)

Perfusion parameter (e.g. flow, pressure, resistance,...)

Markers of organ injury measured in perfusate (e.g. lactate, enzymes,...)

Markers of organ function, representative for a specific cell compound (e.g. mitochondria,...)

We do NOT consider parameters measured during machine perfusion for viability assessment.

Not applicable

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* 45. Do you consider perfusate Lactate (measured during machine perfusion) as reliable parameter to decide to accept a liver for transplantation or not ?

Yes

No - we combine Lactate with other parameters

I don`t know