Thoracoabdominal normothermic regional perfusion: The debate and ethical considerations for nurses

Normothermic regional perfusion is a relatively new organ procurement technique used in the setting of donation after circulatory death. It facilitates blood flow through a specific area of the body to limit and reverse ischemic damage, ultimately improving organ viability for transplant. Despite its lauded benefits of improving organ quantity, quality, and transplant outcomes, the process is both legally and ethically controversial. In particular, normothermic regional perfusion of the thoracic region has generated significant controversy, because (1) this process restarts the heart in the donor's body, which raises questions about the irreversibility of the cessation of circulation, and (2) the requisite steps to mitigate brain perfusion and the risks of collateral perfusion to the brain raise questions about how the donation process may contribute to the maintenance of death. This raises a number of ethical complexities that are unique to nurses, including navigating complex professional dynamics, facilitating difficult conversations, and potentially addressing therapeutic misunderstandings. These features make nurses vulnerable to moral distress in the setting of organ procurement. In this article, we explicate the process of thoracoabdominal normothermic regional perfusion and present key considerations for and against its utilization in organ procurement. Additionally, we provide several overlooked and critical considerations for nurses involved in the organ procurement process, as well as ethical considerations to guide further critical evaluations and implementation.