The Dead Donor Rule and Thoraco-Abdominal Normothermic Regional Perfusion
Friday, October 13, 2023
5:00 PM – 6:15 PM ET
Location: Bristol (Third Floor)
Thoraco-Abdominal Normothermic Regional Perfusion (Hereafter, ‘TA-NRP’) is a proposed method of organ retrieval that can increase both the number and quality of organs available for those in need, especially hearts. However, the procedure is controversial. The ACP has suggested that it violates the 'dead donor rule' - the principle that donors cannot be made dead in order to retrieve their organs and that organ retrieval cannot cause death. Declaration of death entails either the irreversible cessation of the circulatory system or the irreversible cessation of brain activity (a legal standard established by the Uniform Determination of Death Act). Practitioners of TA-NRP begin the process of organ retrieval after the determination of circulatory death. They then proceed by restoring circulatory functioning to the subject and taking direct measures to prevent this circulatory functioning from also restoring brain functioning incidentally. They then maintain that the subject is dead not on circulatory grounds but on the grounds of the cessation of brain activity - an outcome they guaranteed through ligating arteries orplacing intravascular shunts.
A number of attempts have been made to alleviate the worry that TA-NRP violates the dead donor rule, including proposals by Parent et al. and Wall et al. I argue that these attempts have so far been unpersuasive. However, I also suggest that the irreversibility condition in the Uniform Determination of Death Act requires revisiting and that a new understanding of the concept may have downstream consequences for the relation between TA-NRP and the dead donor rule.