Murphy Nicholas B, Slessarev Marat, Basmaji John, Blackstock Laurie, Blaszak Michael, Brahmania Mayur, Chandler Jennifer A, Dhanani Sonny, Gaulton Matthew, Gross Jed A, Healey Andrew, Lingard Lorelei, Ott Mary, Shemie Sam D, Weijer Charles
Department of Medicine and Philosophy, Western University, London, ON, Canada.
Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.
Transplantation. 2025 Apr 1;109(4):597-609. doi: 10.1097/TP.0000000000005161. Epub 2024 Aug 28.
Normothermic regional perfusion (NRP) is a surgical technique that can improve the quality and number of organs recovered for donation after the determination of death by circulatory criteria. Despite its promise, adoption of NRP has been hindered because of unresolved ethical issues. To inform stakeholders, this scoping review provides an impartial overview of the major ethical controversies surrounding NRP. We undertook this review according to a modified 5-step methodology proposed by Arksey and O'Malley. Publications were retrieved through MEDLINE and Embase. Gray literature was sourced from Canadian organ donation organizations, English-language organ donation organization websites, and through our research networks. Three reviewers independently screened all documents for inclusion, extracted data, and participated in content analysis. Disagreements were resolved through consensus meetings. Seventy-one documents substantively engaging with ethical issues in NRP were included for full-text analysis. We identified 6 major themes encompassing a range of overlapping ethical debates: (1) the compatibility of NRP with the dead donor rule, the injunction that organ recovery cannot cause death, (2) the risk of donor harm posed by NRP, (3) uncertainties regarding consent requirements for NRP, (4) risks to stakeholder trust posed by NRP, (5) the implications of NRP for justice, and (6) NRP's potential to benefits of NRP for stakeholders. We found no agreement on the ethical permissibility of NRP. However, some debates may be resolved through additional empirical study. As decision-makers contemplate the adoption of NRP, it is critical to address the ethical issues facing the technique to ensure stakeholder trust in deceased donation and transplantation systems is preserved.
常温区域灌注（NRP）是一种外科技术，在根据循环标准判定死亡后，该技术可提高用于捐赠的器官回收质量和数量。尽管有前景，但由于未解决的伦理问题，NRP的采用受到了阻碍。为了让利益相关者了解情况，本范围综述对围绕NRP的主要伦理争议进行了公正概述。我们根据Arksey和O'Malley提出的改进的五步方法进行了本综述。通过MEDLINE和Embase检索出版物。灰色文献来自加拿大器官捐赠组织、英语器官捐赠组织网站以及我们的研究网络。三位评审员独立筛选所有文件以确定是否纳入，提取数据，并参与内容分析。分歧通过共识会议解决。71篇实质性涉及NRP伦理问题的文件被纳入全文分析。我们确定了6个主要主题，涵盖了一系列重叠的伦理辩论：（1）NRP与死亡捐赠者规则的兼容性，即器官回收不能导致死亡的禁令；（2）NRP对捐赠者造成伤害的风险；（3）NRP同意要求的不确定性；（4）NRP对利益相关者信任构成的风险；（5）NRP对正义的影响；（6）NRP对利益相关者的潜在益处。我们发现对于NRP在伦理上是否可允许没有达成共识。然而，一些辩论可能通过额外的实证研究得到解决。随着决策者考虑采用NRP，解决该技术面临的伦理问题以确保利益相关者对已故捐赠和移植系统的信任得以保留至关重要。
