An Anesthesiologist's Moral Distress With Organ Procurement: A Narrative Review

Area of Science:

• Medical Ethics
• Anesthesiology
• Organ Transplantation

Background:

• Organ procurement procedures have evolved, introducing ethical challenges.
• The dead donor rule (DDR) is a cornerstone of organ donation.
• Novel techniques like donation after circulatory death (DCD) and normothermic regional perfusion (NRP) raise moral uncertainties.

Purpose of the Study:

• To review changes in organ procurement.
• To explore the impact of these changes on anesthesiologists.
• To discuss strategies for managing moral distress in anesthesiology.

Main Methods:

• A narrative review was conducted.
• Searches were performed in Ovid MEDLINE, Embase, and Web of Science.
• Keywords included "anesthesiology", "moral distress", "dead donor rule", "brain death", and "normothermic regional perfusion".

Main Results:

• 18 of 77 identified articles met inclusion criteria.
• Novel procurement techniques like NRP after DCD may cause moral distress.
• Anesthesiologists have limited decision-making control in these new procedures.

Conclusions:

• Anesthesiologists face moral distress due to evolving organ procurement.
• Expanded ethics education, peer support, and institutional backing are crucial.
• Addressing moral distress can enhance anesthesiologist wellness and patient safety.