Intraoperative Brain Monitoring During Thoracoabdominal Normothermic Regional Perfusion: Practical and Ethical...

Area of Science:

• Medical Ethics
• Neurosurgery
• Organ Donation

Background:

• Thoracoabdominal normothermic regional perfusion (TA-NRP) is a complex procedure with ethical considerations.
• Intraoperative brain monitoring is proposed to ensure ethical compliance during TA-NRP.

Purpose of the Study:

• To review unresolved ethical issues surrounding intraoperative brain monitoring in TA-NRP.
• To propose recommendations for managing ethical dilemmas and advancing clinical practice.

Main Methods:

• Ethical analysis of brain monitoring in TA-NRP.
• Assessment of current monitoring techniques, including transcranial doppler (TCD) and cerebral oximetry.
• Discussion of procedural and institutional barriers.

Main Results:

• Preventing inadvertent brain reperfusion is critical for ethical TA-NRP.
• TCD with cerebral oximetry shows promise as an ideal monitor for reperfusion.
• Uncertainty in monitoring findings presents ethical challenges for donors, families, and public trust.

Conclusions:

• Standardizing surgical protocols, including venting, is a necessary first step.
• Further research and data consolidation are needed to address diagnostic uncertainty.
• Addressing ethical questions is crucial for the wider adoption of brain monitoring in TA-NRP.