- Normothermic regional perfusion could mitigate organ shortages and yield superior transplant outcomes by reestablishing abdominal circulation after circulatory death.
- Critics claim NRP kills donors because occluding brain arteries prevents cerebral perfusion when abdominal circulation is restored.
- Author contends NRP, like normothermic machine perfusion, at most preempts death rather than hastens it, so it is not impermissible homicide.
J Med Philos. 2026 Aug 11:jhag020. doi: 10.1093/jmp/jhag020. Online ahead of print.
ABSTRACT
A novel method of organ donation after circulatory death called normothermic regional perfusion (NRP) could mitigate the organ shortage crisis and lead to superior outcomes for organ recipients. In NRP, following a pronouncement of death by circulatory criteria, arteries leading to the brain are occluded and abdominal circulation is reinitiated in situ. A prominent objection to NRP maintains that it kills the donor since the arterial occlusion prevents blood from reaching the brain after circulation is reinitiated. Proponents of this objection recommend that transplant surgeons use normothermic machine perfusion (NMP) instead of NRP. In NMP, organs are removed from the donor’s body and perfused by machines using nutrient-enriched donor blood following the circulatory determination of death. Here I argue that if NRP kills the donor, then so does NMP. But I argue that features of NMP that clear the practice of the charge of impermissible homicide are also present in NRP. Like NMP, NRP at most preemptively causes the donor to die at the same time he would have died otherwise. It does not hasten death.
PMID:42575849 | DOI:10.1093/jmp/jhag020
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