Beyond the Final Heartbeat: Neurological Perspectives on Normothermic Regional Perfusion for Organ Donation after Circulatory Death DOI Creative Commons
Matthew P. Kirschen, Ariane Lewis, Michael Rubin

et al.

Annals of Neurology, Journal Year: 2024, Volume and Issue: 95(6), P. 1035 - 1039

Published: March 19, 2024

Normothermic regional perfusion (NRP) has recently been used to augment organ donation after circulatory death (DCD) improve the quantity and quality of transplantable organs. In DCD‐NRP, withdrawal life‐sustaining therapies cardiopulmonary arrest, patients are cannulated onto extracorporeal membrane oxygenation reestablish blood flow targeted organs including heart. During this process, aortic arch vessels ligated restrict cerebral flow. We review ethical challenges whether brain is sufficiently reperfused through collateral circulation allow reemergence consciousness or pain perception, resumption cardiac activity nullifies patient's prior determination, specific authorization for DCD‐NRP required. ANN NEUROL 2024;95:1035–1039

Language: Английский

Knowledge gaps in heart and lung donation after the circulatory determination of death: Report of a workshop of the National Heart, Lung, and Blood Institute DOI
James L. Bernat, Kiran K. Khush, Sam D. Shemie

et al.

The Journal of Heart and Lung Transplantation, Journal Year: 2024, Volume and Issue: 43(6), P. 1021 - 1029

Published: March 2, 2024

Language: Английский

Citations

6
Normothermic Regional Perfusion in Donation After Circulatory Death for Liver Transplantation: A Narrative Review DOI
Andrea M. Meinders, Mark J. Hobeika, Ian Currie

et al.

Current Surgery Reports, Journal Year: 2024, Volume and Issue: 12(3), P. 15 - 25

Published: Feb. 3, 2024

Language: Английский

Citations

5
Developing and Expanding Deceased Organ Donation to its Maximum Therapeutic Potential: An Actionable Global Challenge From the 2023 Santander Summit DOI
Dale Gardiner, Andrew McGee,

Ali Abdul Kareem Al Obaidli

et al.

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.

Language: Английский

Citations

5
Advancing the Scientific Basis for Determining Death in Controlled Organ Donation After Circulatory Determination of Death DOI Creative Commons
Nicholas B. Murphy, Sam D. Shemie,

A M Capron

et al.

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.

Language: Английский

Citations

4
American Society of Transplant Surgeons Normothermic Regional Perfusion Standards: Ethical, Legal, and Operational Conformance DOI
Anji Wall, Shaheed Merani, Jason N. Batten

et al.

Transplantation, Journal Year: 2024, Volume and Issue: unknown

Published: July 16, 2024

Background. The American Society of Transplant Surgeons convened a multidisciplinary working group to address operational, ethical, and legal considerations surrounding normothermic regional perfusion (NRP) procurement. Methods. group, comprising members from AST across various disciplines including transplant surgery, hepatology, critical care, bioethics, collaborated formulate recommendations guidance for NRP Results. following topics were identified by the as essential standards that need be addressed legal, operational conformance: terminology; conceptualization death in context NRP; communication, logistics, training competency. Conclusions. Fourteen support ethical acceptability United States set expectations conduct procedures are provided.

Language: Английский

Citations

4
Normothermic Regional Perfusion Experience of Organ Procurement Organizations in the US DOI Creative Commons
Marty T. Sellers,

Jennifer L. Philip,

Aleah L. Brubaker

et al.

JAMA Network Open, Journal Year: 2024, Volume and Issue: 7(10), P. e2440130 - e2440130

Published: Oct. 24, 2024

Importance Despite the unmet need for donor organs, organ use from donation after circulatory determination of death (DCD) donors has been limited by inferior transplant outcomes. Normothermic regional perfusion (NRP) improves recipient outcomes and utilization DCD donors. There is variability in NRP policies experience among US procurement organizations (OPOs). Objectives To determine OPO experience, identify operational inconsistencies, explore needs related to NRP. Design, Setting, Participants This survey study included 55 OPOs that had recovered organs completed a on operational, administrative, educational components November December 2023. Data analysis was performed February April 2024. Main Outcome Measures The primary outcome number participating and/or anticipating participation. Secondary were implementation barriers, education practices, future regarding consensus recommendations standards. Results Of respondents, 11 (20%) chief executive officers, 8 (15%) operating 36 (65%) medical directors or clinical officers. Forty-nine facilitated cases: 26 (53%) both thoracoabdominal (TA-NRP) abdominal (A-NRP) cases, 16 (33%) only TA-NRP, 7 (14%) A-NRP. reported 606 cases (421 TA-NRP [69%], 185 A-NRP [31%]); median (range) case (1-52). Fifty-two (95%) thought standardized guidance documents would be helpful. All 49 at center’s request; 39 (80%) initiated nonlocal center. Twenty-three (47%) participated without policy pending approval. Positive hospital feedback received 29 (59%), primarily focused increased transplanted prerecovery communication. Allocation challenges experienced 21 (43%); their volume higher than those with no allocation (11 [3-52] vs 6.5 [1-29]; P = .03). Eleven (22%) incorporated into general education. Conclusions In this OPOs, wide variation existed respect practice. occurred more frequently experience. guidelines standardization desired most decrease maximize gift donation.

Language: Английский

Citations

4
cDCDD-NRP is consistent with US legal standards for determining death DOI

Bradley L. Adams,

Lauren Brenner,

Macey L. Levan

et al.

American Journal of Transplantation, Journal Year: 2022, Volume and Issue: 22(10), P. 2302 - 2305

Published: May 5, 2022

Language: Английский

Citations

17
Ethical Issues in Normothermic Regional Perfusion in Controlled Organ Donation After Determination of Death by Circulatory Criteria: A Scoping Review DOI Creative Commons
Nicholas B. Murphy, Marat Slessarev, John Basmaji

et al.

Transplantation, Journal Year: 2024, Volume and Issue: unknown

Published: Aug. 28, 2024

Normothermic regional perfusion (NRP) is a surgical technique that can improve the quality and number of organs recovered for donation after determination death by circulatory criteria. Despite its promise, adoption NRP has been hindered because unresolved ethical issues. To inform stakeholders, this scoping review provides an impartial overview major controversies surrounding NRP. We undertook according to modified 5-step methodology proposed Arksey O’Malley. Publications were retrieved through MEDLINE Embase. Gray literature was sourced from Canadian organ organizations, English-language organization websites, our research networks. Three reviewers independently screened all documents inclusion, extracted data, participated in content analysis. Disagreements resolved consensus meetings. Seventy-one substantively engaging with issues included full-text identified 6 themes encompassing range overlapping debates: (1) compatibility dead donor rule, injunction recovery cannot cause death, (2) risk harm posed NRP, (3) uncertainties regarding consent requirements (4) risks stakeholder trust (5) implications justice, (6) NRP’s potential benefits stakeholders. found no agreement on permissibility However, some debates may be additional empirical study. As decision-makers contemplate it critical address facing ensure deceased transplantation systems preserved.

Language: Английский

Citations

3
Lethal Donation: Do Physicians Cause Death or Preserve Organs in NRP-cDCD? DOI

Emil J. N. Busch

Transplantation, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 10, 2025

1Faculty of Theology, University Oslo, Norway. Received 21 August 2024. Revision received 25 November Accepted 1 December The author declares no funding or conflicts interest. Correspondence: Emil J. N. Busch, MA, Kalundborgvej 177, 4300 Holbæk, Denmark. ([email protected]).

Language: Английский

Citations

0
Thoracoabdominal normothermic regional perfusion: Is it ethical? DOI Creative Commons
Caner Turan

Bioethics News, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 29, 2025

Abstract Thoracoabdominal normothermic regional perfusion (TA-NRP), a new method of controlled donation after circulatory death, seems to provide more and better organs for patients on organ transplant waiting lists compared standard death. Despite its benefits, the ethical permissibility TA-NRP is currently highly debated issue. The recent statement published by American College Physicians (ACP) highlights reasons these debates. Critics’ main concern that violates Dead Donor Rule. This paper presents an analysis objections raised ACP against argues not only morally permissible but also required where it financially technically feasible. To support this conclusion, concepts ‘resuscitation,’ ‘intention,’ ‘irreversibility,’ ‘permanence,’ ‘impossibility,’ ‘respect’ in context are explored. Additionally, procedure evaluated through lenses Utilitarianism, Kantianism, core principles bioethics, Doctrine Double Effect. demonstrates why ACP’s objection lacks solid moral foundation conflates legal considerations. extra measures needed ensure TA-NRP, emphasizing importance informed consent, additional brain blood flow activity monitoring, contingency plan abort procurement process if sign relevant detected.

Language: Английский

Citations

0