The articles by Bernat, Busch, Dudzinski et al., and Derse illustrate the difficulties with reconciling normothermic regional perfusion (NRP) with the dead donor rule (DDR) (Bernat forthcoming; Busch forthcoming; Dudzinski et al. forthcoming; Derse forthcoming). I appreciate their arguments because they help illuminate the issues that generate a dilemma: either reject NRP or the DDR. I am convinced that the dilemma is unavoidable because the procurement team is involved with determining and securing the death of the donor when circulation restarts. (...) Evidence for this is found in the reasons and recommendations given for blocking blood flow to the brain, both of which betray a lack of certainty over the donor’s vital status. The surgical activity in NRP therefore conflicts with the values the DDR protects: respect for the donor’s life and avoidance of conflict of interest. (shrink)

The implementation of the thoracoabdominal normothermic regional perfusion in organ donation after circulatory determination of death (TANRP-DCDD) protocol is garnering increasing attention and pre...

Since the early 1980s, James Bernat’s scholarship has accompanied and shaped most scientific and policy developments on death determination. In 1981, he, Charles Culver, and Bernard Gert provided a...

Bernat argues for a unified brain-based determination of death (UBDD), noting that it “conceptually justifies” death determination both in Donation after Circulatory Determination of Death (DCDD) a...

In this comment, we propose a short exploration of the differences among the declaration of death, the determination of death, and the concept of death, and how they relate to the ethics and practi...

This issue covers a topic widely being discussed at Ethics Committee meetings around the country, namely the line between life and death in organ procurement. While the debate over whether and when...

Several facts about organ donation and transplantation are not in dispute: (1) there is a shortage of available organs; (2) many potential organ donors die after authorized withdrawal of life-susta...

Two of the lead articles in this issue examine the emerging practice of organ procurement by normothermic regional perfusion (NRP) in terms of whether or not these patients are “dead” at the time t...

In his article, “The Unified Brain-Based Determination of Death Conceptually Justifies Death Determination in DCDD and NRP Protocols,” James Bernat argues that Thoracoabdominal Normothermic Regiona...

The intent of the Uniform Determination of Death Act (UDDA) was to facilitate a consistent legal standard for death and align the law with medical practice throughout the United States subsequent t...

Legal interpretations of the Uniform Determination of Death Act (UDDA) can and have evolved over time. Interpretation of the statutory term “irreversible” (circulation cannot ever resume) to mean “...

Bernat (2024) and Busch (2024) both argue that the clamping of cerebral vasculature in NRP-cDCD ensures sufficient diagnostic certainty of death that the procedure does not violate the Dead Donor R...

In his article, a unified brain-based determination of death is described by James Bernat (2024) as a permanent cessation of systemic circulation causing a permanent cessation of brain circulation...

Old habits die hard; so, it seems, do old arguments. Proponents of thoracoabdominal normothermic regional perfusion (TA-NRP, but more commonly referred to as NRP) continue to proffer arguments and...

Other than the ligation of the aortic arch vessels, extracorporeal cardiopulmonary resuscitation (ECPR) and thoraco-abdominal normothermic regional ­perfusion (TA-NRP) in donation after circulatory...