{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T23:15:45Z","timestamp":1790810145040,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,8,8]],"date-time":"2024-08-08T00:00:00Z","timestamp":1723075200000},"content-version":"vor","delay-in-days":38,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007461","name":"Fondation Brocher","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007461","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Hastings Center Report"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:italic>Normothermic regional perfusion (NRP) is a relatively new approach to procuring organs for transplantation. After circulatory death is declared, perfusion is restored to either the thoracoabdominal organs (in TA\u2010NRP) or abdominal organs alone (in A\u2010NRP) using extracorporeal membrane oxygenation. Simultaneously, surgeons clamp the cerebral arteries, causing a fatal brain injury. Critics claim that clamping the arteries is the proximate cause of death in violation of the dead donor rule and that the procedure is therefore unethical. We disagree. This account does not consider the myriad other factors that contribute to the death of the donor, including the presence of a fatal medical condition, the decision to withdraw life support, and the physician's actions in withdrawing life support and administering medication that may hasten death. Instead, we claim that physicians play a causative role in many of the events that lead to a patient's death and that these actions are often ethically and legally justified. We advance an \u201call things considered\u201d view according to which TA\u2010NRP may be considered ethically acceptable insofar as it avoids suffering and respects the wishes of the patient to improve the lives of others through organ donation. We conclude with a series of critical questions related to the practice of NRP and call for the development of national consensus on this issue in the United States<\/jats:italic>.<\/jats:p>","DOI":"10.1002\/hast.4905","type":"journal-article","created":{"date-parts":[[2024,8,8]],"date-time":"2024-08-08T17:44:02Z","timestamp":1723139042000},"page":"24-31","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["In Defense of Normothermic Regional Perfusion"],"prefix":"10.1002","volume":"54","author":[{"given":"Robert D.","family":"Truog","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel N.","family":"Doernberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,8,8]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.9294"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15772"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOT.0000000000000480"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOT.0000000000001143"},{"key":"e_1_2_10_6_1","unstructured":"American College of Physicians \u201cEthics 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 \u201d April 17 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."},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/hast.1584"},{"key":"e_1_2_10_8_1","unstructured":"J. M.Trahanaset al. \u201cDCD Organ Procurement with Normothermic Regional Perfusion \u201d CTSNet May 2022 https:\/\/www.ctsnet.org\/article\/dcd-organ-procurement-normothermic-regional-perfusion. The video accompanying this brief article \u201cdemonstrates \u201d as the web page explains \u201cthe authors\u2019 technique for the recovery of organs from donation after circulatory death (DCD) donors using normothermic regional perfusion (NRP).\u201d"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1353\/ken.0.0153"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.2307\/3527865"},{"key":"e_1_2_10_11_1","unstructured":"Arnold and Youngner \u201cThe Dead Donor Rule.\u201d"},{"issue":"3","key":"e_1_2_10_12_1","first-page":"277","article-title":"Different Impacts of Time from Collapse to First Cardiopulmonary Resuscitation on Outcomes after Witnessed Out-of-Hospital Cardiac Arrest in Adults","volume":"8","author":"Hara M.","year":"2015","journal-title":"Circulation"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3181c58916"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2022713"},{"key":"e_1_2_10_15_1","unstructured":"Bernat \u201cThe Circulatory-Respiratory Determination of Death in Organ Donation \u201d 965."},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16947"},{"key":"e_1_2_10_17_1","unstructured":"Wall \u201cApplying the Ethical Framework for Donation after Circulatory Death to Thoracic Normothermic Regional Perfusion Procedures.\u201d"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.17002"},{"key":"e_1_2_10_19_1","unstructured":"American College of Physicians \u201cEthics Determination of Death and Organ Transplantation in Normothermic Regional Perfusion (NRP) with Controlled Donation after Circulatory Determination of Death (cDCD) \u201d 2."},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000004642"},{"key":"e_1_2_10_21_1","unstructured":"Ibid. 1653."},{"key":"e_1_2_10_22_1","unstructured":"Haraet al. \u201cDifferent Impacts of Time from Collapse to First Cardiopulmonary Resuscitation on Outcomes after Witnessed Out-of-Hospital Cardiac Arrest in Adults.\u201d"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000004047"},{"key":"e_1_2_10_24_1","unstructured":"Parent \u201cResponse to American College of Physician's Statement on the Ethics of Transplant after Normothermic Regional Perfusion.\u201d"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1988.03720140059034"},{"key":"e_1_2_10_26_1","unstructured":"In the Matter of Karen Ann Quinlan an Alleged Incompetent 355 A.2d 647; or 70 NJ 10 March 31 1976."},{"key":"e_1_2_10_27_1","unstructured":"Ibid."},{"key":"e_1_2_10_28_1","unstructured":"Vacco v. Quill 117 SCt 2293(1997)."},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199411033311822"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1080\/15265161.2022.2159571"},{"key":"e_1_2_10_31_1","unstructured":"Glazier and Capron \u201cNormothermic Regional Perfusion and US Legal Standards for Determining Death Are Not Aligned.\u201d"},{"key":"e_1_2_10_32_1","doi-asserted-by":"crossref","unstructured":"A. L.Brubakeret al. \u201cUS Liver Transplant Outcomes after Normothermic Regional Perfusion vs Standard Super Rapid Recovery \u201dJournal of the American Medical Association Surgery(2024[epub ahead of print]):https:\/\/doi.org\/10.1001\/jamasurg.2024.0520.","DOI":"10.1001\/jamasurg.2024.0520"},{"key":"e_1_2_10_33_1","unstructured":"Wall \u201cThe American Society of Transplant Surgeons Consensus Statement on Normothermic Regional Perfusion.\u201d"},{"key":"e_1_2_10_34_1","unstructured":"OPTN Ethics Committee \u201cEthical Analysis of Normothermic Regional Perfusion \u201d Organ Procurement and Transplantation Network 2023 https:\/\/optn.transplant.hrsa.gov\/policies-bylaws\/public-comment\/ethical-analysis-of-normothermic-regional-perfusion\/."},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1353\/ken.0.0070"},{"key":"e_1_2_10_36_1","volume-title":"Non-Heart-Beating Organ Donation: Medical and Ethical Issues in Procurement","author":"Institute of Medicine","year":"1997"}],"container-title":["Hastings Center Report"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hast.4905","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T19:53:47Z","timestamp":1724356427000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hast.4905"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7]]},"references-count":35,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,7]]}},"alternative-id":["10.1002\/hast.4905"],"URL":"https:\/\/doi.org\/10.1002\/hast.4905","archive":["Portico"],"relation":{},"ISSN":["0093-0334","1552-146X"],"issn-type":[{"value":"0093-0334","type":"print"},{"value":"1552-146X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7]]},"assertion":[{"value":"2024-08-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}