Organ procurement organizations should develop policy regarding surrogate consent for normothermic regional perfusion

Normothermic regional perfusion (NRP) is a postmortem technique that restores oxygenated blood flow to transplantable organs in situ after death determination in donation after circulatory death to improve organ viability and function. Although observational evidence strongly suggests NRP is superior to conventional rapid organ recovery, it has generated ethical controversy internationally. While much of the debate revolves around NRP's compatibility with the dead donor rule, an unresolved ethical question facing organ procurement organizations is whether, in addition to general consent (or "authorization") to organ donation, specific consent to NRP should be sought from surrogate decision makers. As NRP practice continues to evolve and as more jurisdictions consider NRP adoption, developing policy governing NRP consent or notification practices should be a priority for organ procurement organizations. In this Personal Viewpoint article, we outline arguments for and against a consent requirement. We conclude that ongoing ethical controversy and unresolved empirical questions concerning the potential for the resumption of intracranial blood flow during NRP support a cautious, consent-based approach at this stage of NRP's adoption.