Departments of Anesthesiology and Critical Care Medicine, Neurology, and Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Departments of Neurology and Neurosurgery, New York University, Langone Medical Center, New York, NY, USA.
Ann Neurol. 2024 Jun;95(6):1035-1039. doi: 10.1002/ana.26926. Epub 2024 Mar 19.
Normothermic regional perfusion (NRP) has recently been used to augment organ donation after circulatory death (DCD) to improve the quantity and quality of transplantable organs. In DCD-NRP, after withdrawal of life-sustaining therapies and cardiopulmonary arrest, patients are cannulated onto extracorporeal membrane oxygenation to reestablish blood flow to targeted organs including the heart. During this process, aortic arch vessels are ligated to restrict cerebral blood flow. We review ethical challenges including whether the brain is sufficiently reperfused through collateral circulation to allow reemergence of consciousness or pain perception, whether resumption of cardiac activity nullifies the patient's prior death determination, and whether specific authorization for DCD-NRP is required. ANN NEUROL 2024;95:1035-1039.
常温区域性灌注（NRP）最近被用于增加循环死亡（DCD）后的器官捐献，以提高可移植器官的数量和质量。在 DCD-NRP 中，在停止生命维持治疗和心肺停止后，患者被插管到体外膜氧合机上，以重新建立血流到包括心脏在内的目标器官。在此过程中，主动脉弓血管被结扎以限制脑血流。我们回顾了一些伦理挑战，包括大脑是否通过侧支循环得到充分再灌注，从而允许意识或疼痛感知的重新出现，心脏活动的恢复是否使患者先前的死亡判定无效，以及是否需要对 DCD-NRP 进行特定授权。ANN NEUROL 2024；95：1035-1039。
