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

Organ procurement procedures have evolved significantly over the past decade, resulting in new moral uncertainties. The dead donor rule (DDR), a foundational principle, mandates that organ procurement occurs only after death is confirmed. However, developments such as donation after circulatory death (DCD) and normothermic regional perfusion (NRP) have raised ethical issues, creating moral distress and moral injury among anesthesiologists. This review highlights the recent changes in the organ procurement processes and the potential impact on anesthesiologists and also discusses the strategies to prevent and manage moral distress. A narrative review was conducted using a structured search strategy across Ovid MEDLINE, Embase, and Web of Science. The search included the terms "anesthesiology", "moral distress", "dead donor rule", "brain death", and "normothermic regional perfusion". Of the 77 identified articles, 18 met inclusion criteria focusing on the ethical, psychological, and educational aspects of the anesthesiologist's role in organ procurement. The increasing use of novel organ procurement techniques such as NRP after DCD may result in moral distress among anesthesiologists. While the literature on moral distress continues to expand in the healthcare field, more needs to be written on this topic with anesthesiologists involved in organ procurement. Anesthesiologists are participating in novel organ procurement techniques with minimal control of decision-making. As a result, moral distress may occur with negative consequences. Solutions to the identification and prevention of moral distress with organ procurement include expanded ethics education, peer and mentor support, and institutional support. Addressing these issues can empower anesthesiologists to navigate complex scenarios, mitigating moral distress and increasing wellness and patient safety.