Ethical issues in organ procurement: donation after normothermic regional perfusion in liver transplantation

With ongoing organ shortages, new perfusion technologies are being embraced to help fill the unmet requirement. Improvement in utilization of donation after cardiac death (DCD) donors has the potential to greatly expand the pool of usable liver allografts. Normothermic regional perfusion (NRP) has been shown to increase usage of DCD donors and improve recipient outcomes. Yet, there remains heterogeneity in its usage worldwide.

Results from the first US multicenter study show improved biliary outcomes with NRP, consistent with prior data from Europe. Internationally, there are wide variations in DCD and NRP usage, highlighting the opportunities for improvement and increased utilization. The ethics of this technique continue to be considered.

NRP is a sound technique that can improve utilization for DCD donors, thereby increasing organ supply. Its usage is increasing worldwide. New data continue to show the benefit of this procurement strategy. NRP agrees with the principles of ethics.