Comparative analysis highlights ethical similarities in in-situ normothermic regional perfusion and organ donation, suggesting significant implications for future practices.
AnaesthesiaEarly View Editorial Comparing in-situ normothermic regional perfusion with standard deceased donation: ethical similarities Andrew McGee, Andrew McGee orcid.org/0000-0002-5564-9937 Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD, AustraliaSearch for more papers by this authorDrew Carter, Drew Carter orcid.org/0000-0002-1221-6656 Adelaide Health Technology Assessment, School of Public Health, University of Adelaide, Adelaide, SA, AustraliaSearch for more papers by this authorBrendan Parent, Brendan Parent orcid.org/0000-0003-3057-5684 New York University Grossman School of Medicine, New York, NY, USASearch for more papers by this authorDale Gardiner, Corresponding Author Dale Gardiner [email protected] orcid.org/0000-0003-0375-6834 Department of Intensive Care Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK NHS Blood and Transplant, Bristol, UK Correspondence to: Dale Gardiner Email: [email protected]Search for more papers by this author Andrew McGee, Andrew McGee orcid.org/0000-0002-5564-9937 Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD, AustraliaSearch for more papers by this authorDrew Carter, Drew Carter orcid.org/0000-0002-1221-6656 Adelaide Health Technology Assessment, School of Public Health, University of Adelaide, Adelaide, SA, AustraliaSearch for more papers by this authorBrendan Parent, Brendan Parent orcid.org/0000-0003-3057-5684 New York University Grossman School of Medicine, New York, NY, USASearch for more papers by this authorDale Gardiner, Corresponding Author Dale Gardiner [email protected] orcid.org/0000-0003-0375-6834 Department of Intensive Care Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK NHS Blood and Transplant, Bristol, UK Correspondence to: Dale Gardiner Email: [email protected]Search for more papers by this author First published: 01 September 2025 https://doi.org/10.1111/anae.16756Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookxLinkedInRedditWechatBluesky References 1Hessheimer AJ. In situ normothermic regional perfusion in controlled donation after circulatory determination death: organ utilization, outcomes, and elusiveness of a randomized clinical trial. Transplantation 2023; 107: 311–312. https://doi.org/10.1097/TP.0000000000004281. 10.1097/TP.0000000000004281 PubMed Web of Science® Google Scholar 2 American College of Physicians. Ethics, Determination of Death, and Organ Transplantation in Normothermic Regional Perfusion (NRP) with Controlled Donation after Circulatory Determination of Death (cDCD): American College of Physicians Statement of Concern. 2021. https://www.acponline.org/sites/default/files/documents/clinical_information/resources/end_of_life_care/ethics_determination_of_death_and_organ_transplantation_in_nrp_2021.pdf (accessed 27/06/2025). Google Scholar 3DeCamp M, Snyder Sulmasy L, Fins JJ. POINT: does normothermic regional perfusion violate the ethical principles underlying organ procurement? Yes. Chest 2022; 162: 288–290. https://doi.org/10.1016/j.chest.2022.03.012. 10.1016/j.chest.2022.03.012 PubMed Google Scholar 4Glazier AK, Capron AM. Normothermic regional perfusion and US legal standards for determining death are not aligned. Am J Transplant 2022; 22: 1289–1290. https://doi.org/10.1111/ajt.17002. 10.1111/ajt.17002 PubMed Web of Science® Google Scholar 5Peled H, Mathews S, Rhodes D, Bernat JL. Normothermic regional perfusion requires careful ethical analysis before adoption into donation after circulatory determination of death. Crit Care Med 2022; 50: 1644–1648. https://doi.org/10.1097/CCM.0000000000005632. 10.1097/CCM.0000000000005632 PubMed Web of Science® Google Scholar 6Omelianchuk A, Capron AM, Ross LF, Derse AR, Bernat JL, Magnus D. Neither ethical nor prudent: why not to choose normothermic regional perfusion. Hast Cent Rep 2024; 54: 14–23. https://doi.org/10.1002/hast.1584. 10.1002/hast.1584 PubMed Web of Science® Google Scholar 7Dalle Ave AL, Shaw DM, Bernat JL. Ethical issues in the use of extracorporeal membrane oxygenation in controlled donation after circulatory determination of death. Am J Transplant 2016; 16: 2293–2299. https://doi.org/10.1111/ajt.13792. 10.1111/ajt.13792 CAS PubMed Web of Science® Google Scholar 8Entwistle JW, Drake DH, Fenton KN, Smith MA, Sade RM, Cardiothoracic Ethics Forum. Normothermic regional perfusion: ethical issues in thoracic organ donation. J Thorac Cardiovasc Surg 2022; 164: 147–154. https://doi.org/10.1016/j.athoracsur.2022.01.058. 10.1016/j.jtcvs.2022.01.018 PubMed Web of Science® Google Scholar 9Robertson JA. Relaxing the death standard for organ donation in pediatric situations. In: D Mathieu, ed. Organ Substitution Technology: Ethical, Legal, And Public Policy Issues. Boulder, CO: Westview Press, 1988: 69–76. Google Scholar 10Robertson JA. The dead donor rule. Hast Cent Rep 1999; 29: 6–14. https://doi.org/10.2307/3527865. 10.2307/3527865 PubMed Web of Science® Google Scholar 11Nielsen Busch EJ, Mjaaland MT. Does controlled donation after circulatory death violate the dead donor rule? Am J Bioeth 2023; 23: 4–11. https://doi.org/10.1080/15265161.2022.2040646. 10.1080/15265161.2022.2040646 PubMed Google Scholar 12 The National Conference of Commissioners on Uniform State Laws. Determination of Death Act. 1980. https://www.uniformlaws.org/committees/community-home?communitykey=155faf5d-03c2-4027-99ba-ee4c99019d6c&tab=groupdetails (accessed 27/06/2025). Google Scholar 13Bernat JL, Capron AM, Bleck TP, et al. The circulatory-respiratory determination of death in organ donation. Crit Care Med 2010; 38: 963–970. https://doi.org/10.1097/CCM.0b013e3181c58916. 10.1097/CCM.0b013e3181c58916 PubMed Web of Science® Google Scholar 14Bernat JL. The unified brain-based determination of death conceptually justifies death determination in DCDD and NRP protocols. Am J Bioeth 2024; 24: 4–15. https://doi.org/10.1080/15265161.2024.2337392. 10.1080/15265161.2024.2337392 PubMed Web of Science® Google Scholar 15Bernat JL. How the distinction between 'irreversible' and 'permanent' illuminates circulatory-respiratory death determination. J Med Philos 2010; 35: 242–255. https://doi.org/10.1093/jmp/jhq018. 10.1093/jmp/jhq018 PubMed Web of Science® Google Scholar 16Bernat JL, Domínguez-Gil B, Glazier AK, et al. Understanding the brain-based determination of death when organ recovery is performed with DCDD in-situ normothermic regional perfusion. Transplantation 2023; 107: 1650–1654. https://doi.org/10.1097/TP.0000000000004642. 10.1097/TP.0000000000004642 PubMed Web of Science® Google Scholar 17Bernat JL. Are organ donors after cardiac death really dead? J Clin Ethics 2006; 17: 122–132. https://doi.org/10.1086/JCE200617203. 10.1086/JCE200617203 PubMed Google Scholar 18Parent B, Caplan A, Moazami N, Montgomery RA. Response to American College of Physician's statement on the ethics of transplant after normothermic regional perfusion. Am J Transplant 2022; 22: 1307–1310. https://doi.org/10.1111/ajt.16947. 10.1111/ajt.16947 PubMed Web of Science® Google Scholar 19Royo-Villanova M, Miñambres E, Sánchez JM, et al. Maintaining the permanence principle of death during normothermic regional perfusion in controlled donation after the circulatory determination of death: results of a prospective clinical study. Am J Transplant 2024; 24: 213–221. https://doi.org/10.1016/j.ajt.2023.09.008. 10.1016/j.ajt.2023.09.008 PubMed Web of Science® Google Scholar 20Frontera JA, Lewis A, James L, et al. Thoracoabdominal normothermic regional perfusion in donation after circulatory death does not restore brain blood flow. J Heart Lung Transplant 2023; 42: 1161–1165. https://doi.org/10.1016/j.healun.2023.05.010. 10.1016/j.healun.2023.05.010 PubMed Web of Science® Google Scholar 21Royo-Villanova M, Sánchez JM, Moreno-Monsalve T, et al. A scintigraphic look at the dead donor rule in donation after the circulatory determination of death with the use of normothermic regional perfusion: a single-center interventional trial. Am J Transplant 2025; 29: S1600-6135(25)00168–6. https://doi.org/10.1016/j.ajt.2025.03.029. 10.1016/j.ajt.2025.03.029 Google Scholar 22Wijdicks EF, Pfeifer EA. Neuropathology of brain death in the modern transplant era. Neurology 2008; 70: 1234–1237. https://doi.org/10.1212/01.wnl.0000289762.50376.b6. 10.1212/01.wnl.0000289762.50376.b6 PubMed Web of Science® Google Scholar 23Russell JA, Epstein LG, Greer DM, Kirschen M, Rubin MA, Lewis A. Brain death, the determination of brain death, and member guidance for brain death accommodation requests: AAN position statement. Neurology 2019; 92: 228–232. https://doi.org/10.1212/WNL.0000000000006750. 10.1212/WNL.0000000000006750 PubMed Web of Science® Google Scholar 24 Academy of Medical Royal Colleges. A Code of Practice for the Diagnosis and Confirmation of Death. 2025 Update. https://www.aomrc.org.uk/2025-code-of-practice-for-the-diagnosis-and-confirmation-of-death (accessed 27/06/2025). Google Scholar 25Manara A, Shemie SD, Large S, et al. Maintaining the permanence principle for death during in-situ normothermic regional perfusion for donation after circulatory death organ recovery: a United Kingdom and Canadian proposal. Am J Transplant 2020; 20: 2017–2025. https://doi.org/10.1111/ajt.15775. 10.1111/ajt.15775 PubMed Web of Science® Google Scholar Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation
No takes yet. Share an insight, caveat, or question.
McGee et al. (2025) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: