Neither Ethical nor Prudent: Why Not to Choose Normothermic Regional Perfusion

• Published in: The Hastings Center report 2024-07, Vol.54 (4), p.14-23
• Main Authors: Omelianchuk, Adam, Capron, Alexander Morgan, Ross, Lainie Friedman, Derse, Arthur R., Bernat, James L., Magnus, David
• Format: Article
• Language: English
• Subjects: Blood & organ donations; Circulation; clinical ethics; dead donor rule; donation after circulatory determination of death; ethical parsimony; Health care policy; Medical ethics; normothermic machine perfusion; normothermic regional perfusion; organ transplantation; Transplants & implants; trust in medicine
• ISSN: 0093-0334; 1552-146X; 1552-146X
• DOI: 10.1002/hast.1584

In transplant medicine, the use of normothermic regional perfusion (NRP) in donation after circulatory determination of death raises ethical difficulties. NRP is objectionable because it restores the donor's circulation, thus invalidating a death declaration based on the permanent cessation of circulation. NRP's defenders respond with arguments that are tortuous and factually inaccurate and depend on introducing extraneous concepts into the law. However, results comparable to NRP's—more and higher‐quality organs and more efficient allocation—can be achieved by removing organs from deceased donors and using normothermic machine perfusion (NMP) to support the organs outside the body, without jeopardizing confidence in transplantation's legal and ethical foundations. Given the controversy that NRP generates and the convoluted justifications made for it, we recommend a prudential approach we call “ethical parsimony,” which holds that, in the choice between competing means of achieving a result, the ethically simpler one is to be preferred. This approach makes clear that policy‐makers should favor NMP over NRP.