Transplantation,
Journal Year:
2024,
Volume and Issue:
108(11), P. 2197 - 2208
Published: April 19, 2024
In
controlled
organ
donation
after
circulatory
determination
of
death
(cDCDD),
accurate
and
timely
is
critical,
yet
knowledge
gaps
persist.
Further
research
to
improve
the
science
defining
determining
by
criteria
therefore
warranted.
a
workshop
sponsored
National
Heart,
Lung,
Blood
Institute,
experts
identified
opportunities
pertaining
scientific,
conceptual,
ethical
understandings
DCDD
associated
technologies.
This
article
identifies
strategy
inform
biomedical
definition
death,
for
its
determination,
in
cDCDD.
Highlighting
gaps,
we
propose
that
further
needed
observation
period
following
cessation
circulation
pediatric
neonatal
populations,
temporal
relationship
between
brain
function
withdrawal
life-sustaining
measures
all
patient
minimal
pulse
pressures
sustain
blood
flow,
perfusion,
activity,
function.
Additionally,
predictive
tools
estimate
time
asystole
treatment
alternative
monitoring
modalities
establish
circulatory,
brainstem,
are
needed.
The
physiologic
conceptual
implications
postmortem
interventions
resume
cDCDD
donors
likewise
demand
attention
recovery
practices.
Finally,
because
jurisdictionally
variable
definitions
may
impede
collaborative
efforts,
work
required
achieve
consensus
on
rationale
arrest.
Critical Care,
Journal Year:
2023,
Volume and Issue:
27(1)
Published: April 18, 2023
Abstract
Use
of
extracorporeal
membrane
oxygenation
(ECMO)
in
cardiopulmonary
resuscitation,
termed
eCPR,
offers
the
prospect
improving
survival
with
good
neurological
function
after
cardiac
arrest.
After
death,
ECMO
can
also
be
used
for
enhanced
preservation
abdominal
and
thoracic
organs,
designated
normothermic
regional
perfusion
(NRP),
before
organ
recovery
transplantation.
To
optimize
resuscitation
transplantation
outcomes,
healthcare
networks
Portugal
Italy
have
developed
arrest
protocols
that
integrate
use
eCPR
NRP.
Similar
dissemination
its
integration
NRP
USA
raise
novel
ethical
issues
due
to
a
non-nationalized
health
system
an
opt-in
framework
donation,
as
well
other
legal
cultural
factors.
Nonetheless,
investigations
are
ongoing,
both
selectively
employed
clinical
practice.
This
paper
delineates
most
pressing
relevant
considerations
proposes
recommendations
implementation
aim
promote
public
trust
reduce
conflicts
interest.
Transparent
policies
should
rely
on
separate
lifesaving
from
considerations;
robust,
centralized
data
inform
equitable
evidence-based
allocations;
uniform
practices
concerning
decision-making
resource
utilization;
partnership
community
stakeholders,
allowing
patients
make
decisions
about
emergency
care
align
their
values.
Proactively
addressing
these
logistical
challenges
could
enable
USA,
potential
maximize
lives
saved
through
improved
outcomes
increased
donation
opportunities
when
is
unsuccessful
or
not
accordance
individuals’
wishes.
The Hastings Center Report,
Journal Year:
2024,
Volume and Issue:
54(4), P. 14 - 23
Published: May 20, 2024
Abstract
In
transplant
medicine,
the
use
of
normothermic
regional
perfusion
(NRP)
in
donation
after
circulatory
determination
death
raises
ethical
difficulties.
NRP
is
objectionable
because
it
restores
donor's
circulation,
thus
invalidating
a
declaration
based
on
permanent
cessation
circulation.
NRP's
defenders
respond
with
arguments
that
are
tortuous
and
factually
inaccurate
depend
introducing
extraneous
concepts
into
law.
However,
results
comparable
to
NRP's—more
higher‐quality
organs
more
efficient
allocation—can
be
achieved
by
removing
from
deceased
donors
using
machine
(NMP)
support
outside
body,
without
jeopardizing
confidence
transplantation's
legal
foundations.
Given
controversy
generates
convoluted
justifications
made
for
it,
we
recommend
prudential
approach
call
“ethical
parsimony,”
which
holds
that,
choice
between
competing
means
achieving
result,
ethically
simpler
one
preferred.
This
makes
clear
policy‐makers
should
favor
NMP
over
.
Transplantation,
Journal Year:
2024,
Volume and Issue:
109(1), P. 10 - 21
Published: Oct. 22, 2024
On
November
9
and
10,
2023,
the
Organización
Nacional
de
Trasplantes
(ONT),
under
Spanish
Presidency
of
Council
European
Union,
convened
in
Santander
a
Global
Summit
entitled
"Towards
Convergence
Transplantation:
Sufficiency,
Transparency
Oversight."
This
article
summarizes
two
distinct
but
related
challenges
elaborated
at
by
Working
Group
2
that
must
be
overcome
if
we
are
to
develop
expand
deceased
donation
worldwide
achieve
goal
self-sufficiency
organ
transplantation.
Challenge
1:
need
for
unified
concept
death
based
on
permanent
cessation
brain
function.
group
proposed
challenge
1
requires
global
community
work
toward
uniform,
definition
human
death,
conceptually
unifying
circulatory
neurological
criteria
around
function
accepting
is
valid
criterion
determine
death.
2:
reducing
disparities
increasing
utilization
through
after
determination
(DCDD).
DCDD,
expanding
DCDD
situ
normothermic
regional
perfusion,
ex
machine
perfusion
technology.
Recommendations
implementation
described.
American Journal of Transplantation,
Journal Year:
2021,
Volume and Issue:
22(1), P. 294 - 298
Published: Aug. 17, 2021
Lung
transplantation
with
lungs
procured
from
donors
after
circulatory
death
(DCD)
has
been
established
as
an
alternative
technique
to
traditional
donation
brain
(DBD)
comparable
outcomes.
Recently,
in
situ
thoracoabdominal
normothermic
regional
perfusion
(TA-NRP)
emerged
a
novel
employed
the
procurement
of
cardiac
allografts
death.
TA-NRP,
contrast
ex
machine
perfusion,
advantage
allowing
assessment
donor
organs
prior
final
acceptance.
However,
there
are
some
concerns
that
this
may
adversely
impact
quality
lung
allografts.
Here,
we
present
case
successful
bilateral
sequential
patient
postinflammatory
pulmonary
fibrosis
due
acute
respiratory
distress
syndrome
(ARDS),
perfusion.
Apart
lungs,
heart,
liver,
and
kidneys
were
also
successfully
transplanted
donor.
Transplantation,
Journal Year:
2024,
Volume and Issue:
108(11), P. 2197 - 2208
Published: April 19, 2024
In
controlled
organ
donation
after
circulatory
determination
of
death
(cDCDD),
accurate
and
timely
is
critical,
yet
knowledge
gaps
persist.
Further
research
to
improve
the
science
defining
determining
by
criteria
therefore
warranted.
a
workshop
sponsored
National
Heart,
Lung,
Blood
Institute,
experts
identified
opportunities
pertaining
scientific,
conceptual,
ethical
understandings
DCDD
associated
technologies.
This
article
identifies
strategy
inform
biomedical
definition
death,
for
its
determination,
in
cDCDD.
Highlighting
gaps,
we
propose
that
further
needed
observation
period
following
cessation
circulation
pediatric
neonatal
populations,
temporal
relationship
between
brain
function
withdrawal
life-sustaining
measures
all
patient
minimal
pulse
pressures
sustain
blood
flow,
perfusion,
activity,
function.
Additionally,
predictive
tools
estimate
time
asystole
treatment
alternative
monitoring
modalities
establish
circulatory,
brainstem,
are
needed.
The
physiologic
conceptual
implications
postmortem
interventions
resume
cDCDD
donors
likewise
demand
attention
recovery
practices.
Finally,
because
jurisdictionally
variable
definitions
may
impede
collaborative
efforts,
work
required
achieve
consensus
on
rationale
arrest.
