A 20-minute hands-off period with isoelectric electrocardiography (ECG) monitoring is currently required for the declaration of cardiac death in Italy, thus prolonging the warm ischemia time (WIT) during donation after circulatory death (DCD). Normothermic regional perfusion (NRP) can be a valid tool to optimize organ perfusion as a bridge to donation. A 62-year-old woman with catastrophic brain injury due to massive intracranial hemorrage, not fulfilling brain death criteria, underwent controlled DCD after withdrawal of life-sustaining therapies (WLST). NRP was established after a functional WIT of 43 minutes. Despite concerns regarding a prolonged WIT imposed by the national legislation on declaration of cardiac death, NRP was successful in restoring an adequate perfusion to liver and kidneys, as evidenced by a sustained reduction in blood lactate concentration. Liver and kidneys were successfully transplanted after ex vivo machine perfusion.
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