Ramos Hector C, Beers Emily
Clinical Professor of Surgery, Keck School of Medicine University of Southern California.
Department of Palliative Care at LA General Hospital, Ethics Resource Committee at Los Angeles General Medical Center.
Curr Opin Organ Transplant. 2025 Aug 7. doi: 10.1097/MOT.0000000000001246.
Normothermic regional perfusion (NRP) for the donation after circulatory death (DCD) increases the supply and function of organs. However, the procedures used have led to significant ethical controversies. Despite the numerous studies on the subject, moral issues are seldom analyzed comparatively. This article describes and identifies three ethical problems related to NRP, critiquing them with philosophical and ethical suggestions.
Current literature suggests that using oxygenated blood instead of cold perfusion enhances the function of transplanted organs, more pronounced in thoracic organs. The blood perfusion requires surgical maneuvers such as stimulating and restarting the heart while in the patient, leading to criticism based on ethical grounds, relating to declaration of death and violation of the dead donor rule (DDR).
These findings are a significant ethical quandary that threatens to eliminate the use of NRP and jeopardize the benefits mainly to recipients of hearts and lungs. The declaration of death, violation of the dead donor rule, informed consent, and public perception are the main moral criticisms of NRP. Neither the declaration of death nor the dead donor rule is violated, and justice is served through the provision of informed consent, thereby preserving public trust and the donors' wishes.
