The Hastings Center Report,
Год журнала:
2024,
Номер
54(4), С. 14 - 23
Опубликована: Май 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,
Год журнала:
2022,
Номер
106(9), С. 1763 - 1769
Опубликована: Янв. 18, 2022
The
cerebral
effect
of
clamping
following
normothermic
regional
perfusion
(NRP)
in
donation
after
circulatory
death
(DCD)
remains
unknown.
We
investigated
the
reperfusion
during
NRP
and
preventive
on
brain
function
a
porcine
model.In
16
pigs,
intracranial
physiological
parameters
were
recorded,
including
pressure,
blood
(CBF),
temperature,
oxygen.
Additionally,
electroencephalography
(EEG)
somatosensory
evoked
potentials
(SSEPs)
used
to
assess
function.
animals
cannulated
for
heart-lung
machine,
baseline
measurements
performed
before
withdrawal
from
life
support.
After
8
min
mechanical
asystole,
randomly
allocated
clamp
(n
=
8)
or
nonclamp
aortic
arch
vessels.
30
NRP,
monitored
3
h
weaning
(AW).Intracranial
CBF,
oxygen,
temperature
indicated
successful
occlusion
vessels
AW
group
versus
group.
In
group,
EEG
was
isoelectric
SSEPs
absent
all
pigs.
activity
observed
whereas
6
agonal
respiratory
movements
form
gasping
pigs
group.Reperfusion
led
return
activity.
Conversely,
halted
circulation,
ensuring
permanent
cessation
maintaining
determination
DCD.
Neurology,
Год журнала:
2023,
Номер
101(1), С. 30 - 37
Опубликована: Июль 3, 2023
Brain
death,
more
recently
called
death
determination
by
neurologic
criteria,1
is
at
the
nexus
of
current
controversy
as
US
Uniform
Law
Commission
(ULC)
seeks
to
revise
Determination
Death
Act
(UDDA).
The
UDDA
was
developed
in
1980
ULC,
then
National
Conference
Commissioners
for
State
Laws,
conjunction
with
American
Bar
Association,
Medical
and
President's
Study
Ethical
Problems
Medicine
Biomedical
Behavioral
Research.2
designed
2
principal
goals:
enhance
uniformity
among
states
codify
new
based
on
irreversible
cessation
all
functions
brain,
a
condition
that
had
been
concisely
popularly,
though
infelicitously,
termed
"brain
death."3
Commission's
first
report
1981,
Defining
,
provided
conceptual
justification
showed
how
brain
should
be
best
incorporated
into
model
statute
death.4
ULC
effort
extremely
successful
because
large
majority
enacted
verbatim
or
only
minor
modifications.5
The American Journal of Bioethics,
Год журнала:
2024,
Номер
24(6), С. 34 - 37
Опубликована: Июнь 2, 2024
An
adult
university
hospital
ethics
committee
evaluated
a
proposed
TA-NRP
protocol
in
the
fall
of
2018.
The
raised
ethical
concerns
about
violation
Uniform
Determination
Death
Act
and
prohibition
known
as
Dead
Donor
Rule,
with
potential
resultant
legal
consequences.
additional
concern
was
for
increased
mistrust
by
community
organ
donation
transplantation.
responses
to
these
unable
surmount
boundaries
declined
endorse
procedure.
These
endure.
Controlled
donation
after
the
circulatory
determination
of
death
(cDCDD)
has
emerged
as
a
strategy
to
increase
availability
organs
for
clinical
use.
Traditionally,
from
cDCDD
donors
have
been
subject
standard
rapid
recovery
(SRR)
with
poor
posttransplant
outcomes
abdominal
organs,
particularly
liver,
and
limited
organ
utilization.
Normothermic
regional
perfusion
(NRP),
based
on
use
extracorporeal
membrane
oxygenation
devices,
consists
in
situ
that
will
be
transplantation
oxygenated
blood
under
normothermic
conditions
declaration
before
recovery.
NRP
is
potential
solution
address
limitations
traditional
methods.
It
become
normal
practice
several
European
countries
recently
introduced
United
States.
The
increased
occurred
result
growing
body
evidence
its
association
improved
utilization
compared
SRR.
However,
expansion
precluded
by
obstacles
an
organizational,
legal,
ethical
nature.
This
article
details
technique
both
thoracoabdominal
NRP.
Based
available
evidence,
it
describes
benefits
terms
thoracic
addresses
cost-effectiveness
aspects
NRP,
well
logistical
limit
implementation
this
innovative
preservation
strategy.
American Journal of Transplantation,
Год журнала:
2022,
Номер
22(7), С. 1852 - 1860
Опубликована: Апрель 7, 2022
Despite
the
benefits
of
abdominal
normothermic
regional
perfusion
(A-NRP)
for
grafts
in
controlled
donation
after
circulatory
death
(cDCD),
there
is
limited
information
on
effect
A-NRP
quality
cDCD
lungs.
We
aimed
to
study
lungs
obtained
from
and
its
impact
recipients´
outcomes.
This
a
comparing
outcomes
lung
transplants
(LT)
donors
(September
2014
December
2021)
using
as
preservation
method.
As
controls,
all
recipients
transplanted
brain
(DBD)
were
considered.
The
primary
recipient
3-month,
1-year,
5-year
survival.
A
total
269
LT
performed
(60
209
DBD).
There
was
no
difference
survival
at
3
months
(98.3%
vs.
93.7%
DBD),
1
year
(90.9%
87.2%),
5
years
(68.7%
69%).
group
had
higher
rate
graft
dysfunction
grade
72
h
(10%
3.4%;
p
<
.001).
largest
experience
ever
reported
with
use
combined
retrieval
donors.
method
safe
presenting
short-term
equivalent
those
through
DBD.
