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Updated: Jun 24, 2025
Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death
Published on: August 15, 2022
Ethical and Equity Guidance for Transplant Programs Considering Thoracoabdominal Normothermic Regional Perfusion
Denise M Dudzinski1,2, Jay D Pal1, James N Kirkpatrick1,2
1University of Washington School of Medicine.
Insights
Thoracoabdominal normothermic regional perfusion (TA-NRP) for heart donation after circulatory determination of death (DCDD) presents ethical challenges. This analysis provides recommendations for informed consent and ethical decision-making in TA-NRP heart procurement.
Area of Science:
- Transplantation Medicine
- Bioethics
- Organ Procurement
Background:
- Donation after circulatory determination of death (DCDD) is established in the US, but heart procurement remains debated.
- Ex vivo perfusion systems have revived DCDD practices, while thoracoabdominal normothermic regional perfusion (TA-NRP) for in situ organ reanimation raises new ethical questions.
Purpose of the Study:
- To outline practical, ethical, and equity considerations for transplant programs regarding TA-NRP.
- To provide a multidisciplinary analysis of ethical issues in DCDD-NRP heart procurement.
- To offer recommendations for ethical decision-making and informed consent in TA-NRP.
Main Methods:
- Multidisciplinary analysis of ethical issues related to DCDD-NRP heart procurement.
- Examination of the Dead Donor Rule and Uniform Definition of Death Act.
- Development of recommendations for transplant programs and informed consent processes.
Main Results:
- TA-NRP for DCDD heart procurement involves complex ethical considerations.
- Application of existing legal and ethical frameworks requires careful interpretation for TA-NRP.
- Distinguishing informed consent from authorization is crucial for TA-NRP cadaveric organ donation.
Conclusions:
- Transplant programs need comprehensive guidance to navigate the ethical landscape of TA-NRP.
- Ethical analysis and input from all stakeholders are essential for implementing TA-NRP.
- A distinct informed consent process is recommended for TA-NRP cadaveric organ donation to ensure ethical practice.
Abstract:
Donation after circulatory determination of death (DCDD) is an accepted practice in the United States, but heart procurement under these circumstances has been debated. Although the practice is experiencing a resurgence due to the recently completed trials using ex vivo perfusion systems, interest in thoracoabdominal normothermic regional perfusion (TA-NRP), wherein the organs are reanimated in situ prior to procurement, has raised many ethical questions. We outline practical, ethical, and equity considerations to ensure transplant programs make well-informed decisions about TA-NRP. We present a multidisciplinary analysis of the relevant ethical issues arising from DCDD-NRP heart procurement, including application of the Dead Donor Rule and the Uniform Definition of Death Act, and provide recommendations to facilitate ethical analysis and input from all interested parties. We also recommend informed consent, as distinct from typical "authorization," for cadaveric organ donation using TA-NRP.
