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• W4282942255 abstract "The authors reported no conflicts of interest.The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. We thank Entwistle and colleagues for a balanced and thoughtful review of the ethics of normothermic regional perfusion (NRP).1Entwistle J.W. Drake D.H. Fenton K.N. Smith M.A. Sade R.M. Cardiothoracic Ethics ForumNormothermic regional perfusion: ethical issues in thoracic organ donation.J Thorac Cardiovasc Surg. March 31, 2022; ([Epub ahead of print])Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar As an author of the cited section on the unifying concept of death,2Dalle Ave A.L. Bernat J.L. Donation after brain circulation determination of death.BMC Med Ethics. 2017; 18: 15-20Crossref PubMed Scopus (26) Google Scholar we here state our position that thoracoabdominal (TA) NRP is unethical. The unifying concept of death of the donation after circulatory determination of death (DCD) donor requires the permanent cessation of brain circulation and function. In the absence of collateral blood flow to the brainstem, TA-NRP would be consistent with our unifying concept of death. However, we find TA-NRP to be unethical because of the intentional ligation of the arch vessels (ILAV). Animal data show that even after 8 minutes of asystole, NRP can restore clinical function of the brainstem and electroencephalographic activity in the absence of ILAV.3Dalsgaard F.F. Moeslund N. Zhang Z.L. Pedersen M. Qerama E. Beniczky S. et al.Clamping of the aortic arch vessels during normothermic regional perfusion after circulatory death prevents the return of brain activity in a porcine model.Transplantation. January 18, 2022; ([Epub ahead of print])Crossref PubMed Scopus (8) Google Scholar The standard death declaration after 5 minutes of asystole in the DCD requires that the cessation of brain circulation is permanent. In the absence of the intervention of ILAV by the transplant surgeon, restoration of systemic circulation restores brain function. But with ILAV, brain blood flow does not resume solely because of the action taken to ensure that brain resuscitation will not succeed. ILAV can be plausibly viewed as causing death by preventing brain blood flow during resuscitation. This biological fact is not mitigated by donor desires or utilitarian benefits. A dichotomy between flow to the heart and brain was not anticipated in the original framing of DCD. We do support DCD,4Dalle Ave A.L. Sulmasy D.P. Bernat J.L. The ethical obligation of the dead donor rule.Med Health Care Philos. 2020; 23: 43-50https://doi.org/10.1007/s11019-019-09904-8Crossref PubMed Scopus (15) Google Scholar including direct procurement of hearts. We conclude that ILAV is an unethical addition to DCD because it contrives to prevent brain resuscitation during circulatory restoration. This was one of several reasons that a Canadian consensus conference did not support NRP-TA.5Shemie S.D. Torrance S. Wilson L. Hornby L. MacLean J. Mohr J. et al.Heart donation and transplantation after circulatory determination of death: expert guidance from a Canadian consensus building process.Can J Anaesth. 2021; 68: 661-671https://doi.org/10.1007/s12630-021-01926-2Crossref PubMed Scopus (10) Google Scholar Normothermic regional perfusion: Ethical issues in thoracic organ donationThe Journal of Thoracic and Cardiovascular SurgeryVol. 164Issue 1PreviewNearly 3000 heart transplants are performed annually in the United States, yet several hundred listed patients and several thousand unlisted patients die each year because of lack of an available organ.1 Controlled donation after circulatory-determined death (cDCD) is a potential source of additional hearts for transplantation, but is rarely used for cardiac transplantation: in 2019, no hearts were used from the 2718 cDCD donors that year.2 Heart procurement efforts from cDCD donors have used 2 main techniques: direct procurement and perfusion (DPP) and normothermic regional perfusion (NRP). Full-Text PDF Reply from authors: Tying off brain vessels: Can that be ok?The Journal of Thoracic and Cardiovascular SurgeryVol. 164Issue 2PreviewWe appreciate the comments and analysis of Peled and Bernat,1 whose contributions to the ethics of organ donation we recognize and value. Our paper was a consensus document from the Cardiothoracic Ethics Forum and represents the majority view of the Forum participants.2 Some participants agreed with Peled and Bernat's position, so we raised and discussed similar concerns in our paper, including the view that additional study is needed for deeper scientific understanding of brain function in thoracoabdominal normothermic regional perfusion (TA-NRP). Full-Text PDF" @default.
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• W4282942255 title "Why arch vessel ligation is unethical for thoracoabdominal normothermic regional perfusion" @default.
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