In Defense of Normothermic Regional Perfusion DOI
Robert D. Truog, Samuel N. Doernberg

The Hastings Center Report, Journal Year: 2024, Volume and Issue: 54(4), P. 24 - 31

Published: July 1, 2024

Abstract Normothermic regional perfusion (NRP) is a relatively new approach to procuring organs for transplantation. After circulatory death declared, restored either the thoracoabdominal (in TA‐NRP) or abdominal alone A‐NRP) using extracorporeal membrane oxygenation. Simultaneously, surgeons clamp cerebral arteries, causing fatal brain injury. Critics claim that clamping arteries proximate cause of in violation dead donor rule and procedure therefore unethical. We disagree. This account does not consider myriad other factors contribute donor, including presence medical condition, decision withdraw life support, physician's actions withdrawing support administering medication may hasten death. Instead, we physicians play causative role many events lead patient's these are often ethically legally justified. advance an “all things considered” view according which TA‐NRP be considered acceptable insofar as it avoids suffering respects wishes patient improve lives others through organ donation. conclude with series critical questions related practice NRP call development national consensus on this issue United States .

Language: Английский

The Rapidly Evolving Landscape of DCD Heart Transplantation DOI Creative Commons
Yashutosh Joshi, Katherine Wang,

Campbell MacLean

et al.

Current Cardiology Reports, Journal Year: 2024, Volume and Issue: unknown

Published: Oct. 9, 2024

Abstract Purpose of Review To summarise current international clinical outcomes from donation after circulatory death heart transplantation (DCD-HT); discuss procurement strategies, their impact on and overall organ procurement; identify novel approaches future areas for research in DCD-HT. Recent Findings Globally, DCD-HT survival (regardless strategy) are comparable to brain dead donors (BDD). Experience with normothermic machine perfusion sees improvement rates primary graft dysfunction. Techniques have evolved reduce cold ischaemic exposure directly procured DCD hearts, though controlled periods ischaemia can likely be tolerated. There is interest hypothermic (HMP) promising early results. Summary Survival firmly established equivalent between BDD Procurement strategy (direct vs. regional perfusion) remains a source debate. Methods improve allograft warm tolerance will key the uptake HMP hearts.

Language: Английский

Citations

4
Ethical Issues in Uncontrolled Donation After Circulatory Determination of Death: A Scoping Review to Reveal Areas of Broad Consensus, and Those for Future Research DOI Creative Commons

Αναστασία Γεωργίου,

Weiyi Tan, M Ionescu

et al.

Transplant International, Journal Year: 2025, Volume and Issue: 38

Published: Feb. 6, 2025

Uncontrolled donation after circulatory determination of death (uDCD) protocols are established in several countries with good outcomes. We reviewed the literature between 1997 and 2024 to identify ethical issues. 33 papers were identified. Several areas continued debate delineated: role advanced life support techniques; acceptability aortic occlusion balloons; nature timing consent organ preserving whether best interests can/should extend beyond individual bodily integrity this context. Further empirical research analyses needed these domains. Broad consensus was identified on issues including: decisions about termination resuscitation entry into a uDCD protocol should be made by different teams; at least 20-30 min cardio-pulmonary is required; hands-off period 5-7 required alongside continuous monitoring; techniques as minimally invasive possible; families approached early discuss trained staff; public knowledge engagement poor must improved; transparency informed essential for potential recipients. To maintain encourage positive we propose name change from Organ Donation Sudden Irreversible Cardiac Arrest (ODASICA).

Language: Английский

Citations

0
Ethical and legal considerations in normothermic regional perfusion for donation after circulatory death DOI
O Walker, Giuliano Testa, Anji Wall

et al.

Current Opinion in Critical Care, Journal Year: 2025, Volume and Issue: unknown

Published: March 7, 2025

Purpose of review This study aims to examine the ethical and legal discourse surrounding normothermic regional perfusion (NRP) for donation after circulatory death (DCD). Recent findings NRP is well established within Europe but faces challenges in US not utilized a variety other countries. compliance with dead donor rule (DDR) Uniform Declaration Death Act (UDDA) most significant recently addressed issue. Additionally, procedures raise concerns regarding public education, informed consent, engagement, trust. Inconsistent regulation – such as US– cause concern anticipated increase frequency support organ recovery transplantation. There no single repository technical outcome data practice refinement key aspect given variation between centers Summary NRP-based presents be by transplantation clinicians organizations conjunction representatives. Additional inquiry into determination death, family information needs authorization, coordinated needed ensure that are appropriately addressed. Public engagement essential bolster preserve

Language: Английский

Citations

0
Living Donor Liver Transplant Programs in the United States Need to Be Carefully Nurtured Amidst Expanding Use of Perfusion Technology DOI Open Access
Sorabh Kapoor, Chirag S. Desai

Journal of Clinical Medicine, Journal Year: 2025, Volume and Issue: 14(7), P. 2259 - 2259

Published: March 26, 2025

Living donor transplantation constitutes a small portion of total transplants in the United States as compared Southeast Asia and Middle East. Recent consensus meeting has identified reluctance on part transplant providers financial concerns major hindrance increasing liver US. There is need to carefully analyze recent outcome data from across globe large volume North American centers that clearly establishes benefit for both adults children reducing wait list mortality. LDLT also provides an opportunity expanding indications offer like colorectal metastasis intrahepatic cholangiocarcinoma without number livers available traditional indications. expansion perfusion technology demonstrated significant increase utilization Non heart beating over last few years. However, with simultaneous patients being added list, mortality dropouts have been persistently high. In this opinion piece, authors looked at trends US years advocate adopting complementary rather than singular approach along new technologies

Language: Английский

Citations

0
In Defense of Normothermic Regional Perfusion DOI
Robert D. Truog, Samuel N. Doernberg

The Hastings Center Report, Journal Year: 2024, Volume and Issue: 54(4), P. 24 - 31

Published: July 1, 2024

Abstract Normothermic regional perfusion (NRP) is a relatively new approach to procuring organs for transplantation. After circulatory death declared, restored either the thoracoabdominal (in TA‐NRP) or abdominal alone A‐NRP) using extracorporeal membrane oxygenation. Simultaneously, surgeons clamp cerebral arteries, causing fatal brain injury. Critics claim that clamping arteries proximate cause of in violation dead donor rule and procedure therefore unethical. We disagree. This account does not consider myriad other factors contribute donor, including presence medical condition, decision withdraw life support, physician's actions withdrawing support administering medication may hasten death. Instead, we physicians play causative role many events lead patient's these are often ethically legally justified. advance an “all things considered” view according which TA‐NRP be considered acceptable insofar as it avoids suffering respects wishes patient improve lives others through organ donation. conclude with series critical questions related practice NRP call development national consensus on this issue United States .

Language: Английский

Citations

2