Ethical Considerations in Expanding Available Donor Hearts through Normothermic Regional Perfusion
Friday, October 13, 2023
5:00 PM – 6:15 PM ET
Location: Bristol (Third Floor)
Donation after cardiac death (DCD) increases the available abdominal organs and lungs for transplant, but the Dead Donor Rule (DDR) presents ongoing challenging for DCD donor heart transplants. The DDR requires donors be irreversibly dead for the recovery of vital organs, and that the donation of vital organs not be the cause of a person’s demise. Recently, normothermic regional perfusion (NRP), a procedure that, following cardiac arrest, restores both oxygenated blood flow to the body along with a heartbeat, has been used to help recover DCD hearts. In NRP cases for heart recovery, adherence to the DDR is maintained by occluding the carotid arteries to prevent recirculation of oxygenated blood to the brain. Uncertainty about the status of NRP donors after heart restart raises moral and practical concerns for organ donation. Technological advancements such as NRP blur the distinction between life and death, creating the possibility of violating the DDR and harming the donor. Additionally, the public’s perception is such that organ donation will only occur if the donor is explicitly dead, and that in the absence of brain death a beating heart indicates life rather than death. Perceptions that the DDR has been violated may lead to a loss of public trust in and fewer people opting-in to organ donation. While NRP can help expand available donor hearts for transplant from DCD donors, the ethical implications must first be considered to prevent moral and actual harm and to ensure continued public trust in organ donation.