The US organ transplant system has approved the first national policy for normothermic regional perfusion, a procedure used to remove organs from hospital patients. The guidelines, designed to protect potential donors, aim to address concerns over the procedure's ethics. The policy was approved by the Organ Procurement & Transplantation Network's board of directors on November 6. The new guidelines will go into effect on December 6.
Normothermic regional perfusion, or NRP, is used after a family has decided to withdraw care from a patient with no hope of meaningful recovery. The procedure involves attaching an external pump to the donor to restore blood flow to their organs, keeping them from deteriorating. Dr. Raymond Lynch, director of transplantation at the Health Resources & Services Administration, says NRP could help solve the chronic organ shortage.
The organ shortage is a pressing issue in the US, with over 109,000 Americans waiting for an organ transplant. About 12 people die every day due to the shortage. NRP aims to increase the supply and quality of organs. However, critics argue that the procedure is unethical, as it violates the Dead Donor Rule, a fundamental rule protecting potential donors.
The Dead Donor Rule states that transplant surgeons can only take organs from patients after they are dead due to brain death or circulatory death. Critics claim that NRP reverses the condition upon which the person was declared dead. Dr. Lainie Friedman Ross, a University of Rochester bioethicist, says NRP takes organs from people who are no longer dead.
Another concern with NRP is the potential for blood to be restored to the brain during the procedure. Dr. Claire Morgan, a transplant surgeon, reports that alarm bells went off for organ retrieval teams when blood appeared to get restored to the brain during some NRP cases. The new guidelines aim to address this issue by requiring surgeons to cut holes in the blood vessels to the brain, in addition to clamping them.
Despite the new safeguards, critics argue that the policy is insufficient. Most surgeons already clamp and vent blood vessels to the brain, and the new policy does not address the bigger concerns around NRP. Dr. Matthew DeCamp, a University of Colorado bioethicist, says the policy is premature and does not resolve the fundamental issues around NRP.
Dr. Lynch, however, argues that the new guidelines will protect donors and that NRP is ethical. He says the policy is an important first step to ensure NRP care is available while prioritizing the safety of the donor. The policy's implementation will be closely watched by critics and supporters alike.
Key points
- The US organ transplant system has approved new guidelines for normothermic regional perfusion, a procedure aimed at increasing the supply and quality of organs.
- Critics argue that the procedure is unethical, as it violates the Dead Donor Rule and may not ensure the donor is dead.
- The new policy aims to address concerns over the procedure's ethics, but critics say it is insufficient and premature.
