Thoracoabdominal normothermic regional perfusion: Is it ethical?

Area of Science:

• Medical Ethics
• Transplantation Medicine
• Bioethics

Background:

• Controlled donation after circulatory death (cDCD) is a standard organ procurement method.
• Thoracoabdominal normothermic regional perfusion (TA-NRP) is an emerging technique for cDCD, potentially increasing organ availability and quality.
• Ethical debates, particularly concerning the Dead Donor Rule, surround TA-NRP, as highlighted by the American College of Physicians (ACP).

Purpose of the Study:

• To conduct an ethical analysis of the objections raised against TA-NRP, specifically those from the ACP.
• To argue for the moral permissibility and, in feasible circumstances, the moral requirement of employing TA-NRP.
• To explore key ethical concepts and philosophical frameworks relevant to TA-NRP.

Main Methods:

• Ethical analysis of objections to TA-NRP.
• Exploration of concepts: resuscitation, intention, irreversibility, permanence, impossibility, and respect.
• Evaluation through Utilitarianism, Kantianism, core bioethical principles, and the Doctrine of Double Effect.

Main Results:

• The ACP's objections to TA-NRP are found to lack a solid moral foundation and conflate moral and legal issues.
• TA-NRP is ethically permissible and potentially morally required when financially and technically feasible.
• Existing ethical frameworks support the moral permissibility of TA-NRP under specific conditions.

Conclusions:

• TA-NRP is ethically justifiable and aligns with established bioethical principles.
• Additional safeguards, including informed consent and enhanced monitoring, are crucial for ensuring TA-NRP's moral permissibility.
• The procedure necessitates a contingency plan to halt organ procurement if signs of relevant brain activity emerge.