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The Challenge of Framing the Discourse of Normothermic Regional Perfusion

Michael A. Rubin

American Journal of Bioethics 24 (6):60-62 (2024)

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The Unified Brain-Based Determination of Death Conceptually Justifies Death Determination in DCDD and NRP Protocols.James L. Bernat - 2024 - American Journal of Bioethics 24 (6):4-15.details Organ donation after the circulatory determination of death requires the permanent cessation of circulation while organ donation after the brain determination of death requires the irreversible cessation of brain functions. The unified brain-based determination of death connects the brain and circulatory death criteria for circulatory death determination in organ donation as follows: permanent cessation of systemic circulation causes permanent cessation of brain circulation which causes permanent cessation of brain perfusion which causes permanent cessation of brain function. The relevant circulation that (...) Download Export citation Bookmark 16 citations
An Ethics Committee’s Evaluation of Normothermic Regional Perfusion (NRP) in 2018–Unsatisfactory Answers Then—and Now.Arthur R. Derse - 2024 - American Journal of Bioethics 24 (6):34-37.details An adult university hospital ethics committee evaluated a proposed TA-NRP protocol in the fall of 2018. The protocol raised ethical concerns about violation of the Uniform Determination of Death Act and the prohibition known as the Dead Donor Rule, with potential resultant legal consequences. An additional concern was the potential for increased mistrust by the community of organ donation and transplantation. The ethics committee evaluated the responses to these concerns as unable to surmount the ethical and legal boundaries and the (...) Download Export citation Bookmark 8 citations
Ethical and Equity Guidance for Transplant Programs Considering Thoracoabdominal Normothermic Regional Perfusion (TA-NRP) for Procurement of Hearts.Denise M. Dudzinski, Jay D. Pal & James N. Kirkpatrick - 2024 - American Journal of Bioethics 24 (6):16-26.details Donation after circulatory determination of death (DCDD) is an accepted practice in the United States, but heart procurement under these circumstances has been debated. Although the practice is experiencing a resurgence due to the recently completed trials using ex vivo perfusion systems, interest in thoracoabdominal normothermic regional perfusion (TA-NRP), wherein the organs are reanimated in situ prior to procurement, has raised many ethical questions. We outline practical, ethical, and equity considerations to ensure transplant programs make well-informed decisions about TA-NRP. We (...) Download Export citation Bookmark 9 citations
Restoring the Organism as a Whole: Does NRP Resurrect the Dead?Emil J. N. Busch - 2024 - American Journal of Bioethics 24 (6):27-33.details The introduction of normothermic regional perfusion (NRP) in controlled donation after circulatory determination of death (cDCDD) protocols is by some regarded as controversial and ethically troublesome. One of the main concerns that opponents have about introducing NRP in cDCDD protocols is that reestablishing circulation will negate the determination of death by circulatory criteria, potentially resuscitating the donor. In this article, I argue that this is not the case. If we take a closer look at the concept of death underlying the (...) Download Export citation Bookmark 9 citations

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