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Dudzinski DM, Pal JD, Kirkpatrick JN. Ethical and Equity Guidance for Transplant Programs Considering Thoracoabdominal Normothermic Regional Perfusion (TA-NRP) for Procurement of Hearts. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:16-26. [PMID: 38829597 DOI: 10.1080/15265161.2024.2337393] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Donation after circulatory determination of death (DCDD) is an accepted practice in the United States, but heart procurement under these circumstances has been debated. Although the practice is experiencing a resurgence due to the recently completed trials using ex vivo perfusion systems, interest in thoracoabdominal normothermic regional perfusion (TA-NRP), wherein the organs are reanimated in situ prior to procurement, has raised many ethical questions. We outline practical, ethical, and equity considerations to ensure transplant programs make well-informed decisions about TA-NRP. We present a multidisciplinary analysis of the relevant ethical issues arising from DCDD-NRP heart procurement, including application of the Dead Donor Rule and the Uniform Definition of Death Act, and provide recommendations to facilitate ethical analysis and input from all interested parties. We also recommend informed consent, as distinct from typical "authorization," for cadaveric organ donation using TA-NRP.
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Affiliation(s)
- Denise M Dudzinski
- University of Washington School of Medicine
- University of Washington School of Medicine Ethics Consultation Service
| | - Jay D Pal
- University of Washington School of Medicine
| | - James N Kirkpatrick
- University of Washington School of Medicine
- University of Washington School of Medicine Ethics Consultation Service
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2
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Busch EJN. Restoring the Organism as a Whole: Does NRP Resurrect the Dead? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:27-33. [PMID: 38829586 DOI: 10.1080/15265161.2024.2337403] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
The introduction of normothermic regional perfusion (NRP) in controlled donation after circulatory determination of death (cDCDD) protocols is by some regarded as controversial and ethically troublesome. One of the main concerns that opponents have about introducing NRP in cDCDD protocols is that reestablishing circulation will negate the determination of death by circulatory criteria, potentially resuscitating the donor. In this article, I argue that this is not the case. If we take a closer look at the concept of death underlying the circulatory criterion for determination of death, we find that the purpose of the criterion is to show whether the organism as a whole has died. I argue that this purpose is fulfilled by the circulatory criterion in cDCDD protocols, and that applying NRP does not negate the determination of death or resuscitate the donor.
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3
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Batten JN, Nurok M, Cotler MP, Adams BL, Hasz R, Croome KP, Hoffman J, Wall A. Moving Forward With Normothermic Regional Perfusion Amidst Ethical Controversy. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:41-43. [PMID: 38829602 DOI: 10.1080/15265161.2024.2337431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
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4
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Kirschen MP, Lewis A, Rubin MA, Varelas PN, Greer DM. Beyond the Final Heartbeat: Neurological Perspectives on Normothermic Regional Perfusion for Organ Donation after Circulatory Death. Ann Neurol 2024; 95:1035-1039. [PMID: 38501716 DOI: 10.1002/ana.26926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 02/28/2024] [Accepted: 03/09/2024] [Indexed: 03/20/2024]
Abstract
Normothermic regional perfusion (NRP) has recently been used to augment organ donation after circulatory death (DCD) to improve the quantity and quality of transplantable organs. In DCD-NRP, after withdrawal of life-sustaining therapies and cardiopulmonary arrest, patients are cannulated onto extracorporeal membrane oxygenation to reestablish blood flow to targeted organs including the heart. During this process, aortic arch vessels are ligated to restrict cerebral blood flow. We review ethical challenges including whether the brain is sufficiently reperfused through collateral circulation to allow reemergence of consciousness or pain perception, whether resumption of cardiac activity nullifies the patient's prior death determination, and whether specific authorization for DCD-NRP is required. ANN NEUROL 2024;95:1035-1039.
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Affiliation(s)
- Matthew P Kirschen
- Departments of Anesthesiology and Critical Care Medicine, Neurology, and Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ariane Lewis
- Departments of Neurology and Neurosurgery, New York University, Langone Medical Center, New York, NY, USA
| | - Michael A Rubin
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - David M Greer
- Department of Neurology, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
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5
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Bernat JL. The Unified Brain-Based Determination of Death Conceptually Justifies Death Determination in DCDD and NRP Protocols. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:4-15. [PMID: 38829591 DOI: 10.1080/15265161.2024.2337392] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Organ donation after the circulatory determination of death requires the permanent cessation of circulation while organ donation after the brain determination of death requires the irreversible cessation of brain functions. The unified brain-based determination of death connects the brain and circulatory death criteria for circulatory death determination in organ donation as follows: permanent cessation of systemic circulation causes permanent cessation of brain circulation which causes permanent cessation of brain perfusion which causes permanent cessation of brain function. The relevant circulation that must cease in circulatory death determination is that to the brain. Eliminating brain circulation from the donor ECMO organ perfusion circuit in thoracoabdominal NRP protocols satisfies the unified brain-based determination of death but only if the complete cessation of brain circulation can be proved. Despite its medical and physiologic rationale, the unified brain-based determination of death remains inconsistent with the Uniform Determination of Death Act.
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DeCamp MW, Snyder Sulmasy L. NRP: Neither Perfusion nor Regional. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:50-53. [PMID: 38829588 DOI: 10.1080/15265161.2024.2337427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
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7
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Ott M, Murphy N, Lingard L, Slessarev M, Blackstock L, Basmaji J, Brahmania M, Healey A, Shemie S, Skaro A, Weijer C. Sowing "seeds of trust": How trust in normothermic regional perfusion is built in a continuum of care. Am J Transplant 2024:S1600-6135(24)00345-9. [PMID: 38825154 DOI: 10.1016/j.ajt.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 06/04/2024]
Abstract
Normothermic regional perfusion (NRP) is a promising technology to improve organ transplantation outcomes by reversing ischemic injury caused by controlled donation after circulatory determination of death. However, it has not yet been implemented in Canada due to ethical questions. These issues must be resolved to preserve public trust in organ donation and transplantation. This qualitative, constructivist grounded theory study sought to understand how those most impacted by NRP perceived the ethical implications. We interviewed 29 participants across stakeholder groups of donor families, organ recipients, donation and transplantation system leaders and care providers. The interview protocol included a short presentation about the purpose of NRP and procedures in abdomen versus chest and abdomen NRP, followed by questions probing potential violations to the dead donor rule and concerns regarding brain reperfusion. The results present a grounded theory placing NRP within a trust-building continuum of care for the donor, their family, and organ recipients. Stakeholders consistently described both forms of NRP as an ethical intervention, but their rationales were predicated on assumptions that neurological criteria for death had been met following circulatory death determination. Empirical validation of these assumptions will help ground the implementation of NRP in a trust-preserving way.
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Affiliation(s)
- Mary Ott
- Faculty of Education, York University, Toronto, Ontario, Canada; Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Nicholas Murphy
- Philosophy and Medicine, Western University, London, Ontario, Canada
| | - Lorelei Lingard
- Centre for Education Research and Innovation and Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Marat Slessarev
- Department of Medicine, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada; Regional Medical Lead, Trillium Gift of Life Network, Toronto, Ontario, Canada
| | | | - John Basmaji
- Departments of Medicine and Epidemiology & Biostatistics, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Mayur Brahmania
- Division of Gastroenterology, Department of Medicine, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Andrew Healey
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Trillium Gift of Life Network, Toronto, Ontario, Canada
| | - Sam Shemie
- Division of Critical Care Medicine, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Canadian Blood Services, Ottawa, Ontario, Canada
| | - Anton Skaro
- Department of Surgery, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Charles Weijer
- Departments of Medicine, Epidemiology & Biostatistics, and Philosophy, Western University, London, Ontario, Canada; Canadian Donation and Transplantation Research Program, Alberta, Canada
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Omelianchuk A, Capron AM, Ross LF, Derse AR, Bernat JL, Magnus D. Neither Ethical nor Prudent: Why Not to Choose Normothermic Regional Perfusion. Hastings Cent Rep 2024. [PMID: 38768312 DOI: 10.1002/hast.1584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
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.
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Kim CH. Disparities in transplantation due to the use of ECMO in normothermic regional perfusion. Pediatr Pulmonol 2024; 59:1487-1488. [PMID: 38258914 DOI: 10.1002/ppul.26886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/13/2024] [Indexed: 01/24/2024]
Affiliation(s)
- Christopher H Kim
- Science & Technology Studies Department, Cornell University, Ithaca, New York, USA
- Edmund D. Pellegrino Center for Clinical Bioethics, Georgetown University Medical Center, Washington, DC, USA
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Truby LK, Khazanie P, Farr M. Addressing United States Heart Transplant Allocation in an Era of Rapid Innovation. JACC. HEART FAILURE 2024; 12:216-221. [PMID: 37804311 DOI: 10.1016/j.jchf.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Lauren K Truby
- Section of Advanced Heart Failure and Transplantation, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Prateeti Khazanie
- Section of Advanced Heart Failure and Transplantation, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Maryjane Farr
- Section of Advanced Heart Failure and Transplantation, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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11
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Esbensen K, Prager K. Organ Procurement Using Normothermic Regional Perfusion. JAMA 2023; 330:1389-1390. [PMID: 37815572 DOI: 10.1001/jama.2023.16884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Affiliation(s)
- Kari Esbensen
- Emory Center for Ethics, Emory University School of Medicine, Atlanta, Georgia
| | - Kenneth Prager
- Columbia University College of Physicians and Surgeons, Columbia University Medical Center, New York, New York
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Frontera JA, Lewis A, James L, Melmed K, Parent B, Raz E, Hussain ST, Smith DE, Moazami N. Thoracoabdominal normothermic regional perfusion in donation after circulatory death does not restore brain blood flow. J Heart Lung Transplant 2023; 42:1161-1165. [PMID: 37211334 DOI: 10.1016/j.healun.2023.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/28/2023] [Accepted: 05/14/2023] [Indexed: 05/23/2023] Open
Abstract
Use of thoracoabdominal normothermic regional perfusion (TA-NRP) during donation after circulatory death (DCD) is an important advance in organ donation. Prior to establishing TA-NRP, the brachiocephalic, left carotid, and left subclavian arteries are ligated, thereby eliminating anterograde brain blood flow via the carotid and vertebral arteries. While theoretical concerns have been voiced that TA-NRP after DCD may restore brain blood flow via collaterals, there have been no studies to confirm or refute this possibility. We evaluated brain blood flow using intraoperative transcranial Doppler (TCD) in two DCD TA-NRP cases. Pre-extubation, anterior and posterior circulation brain blood flow waveforms were present in both cases, similar to the waveforms detected in a control patient on mechanical circulatory support undergoing cardiothoracic surgery. Following declaration of death and initiation of TA-NRP, no brain blood flow was detected in either case. Additionally, there was absence of brainstem reflexes, no response to noxious stimuli and no respiratory effort. These TCD results demonstrate that DCD with TA-NRP did not restore brain blood flow.
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Affiliation(s)
- Jennifer A Frontera
- Department of Neurology, Division of Neurocritical Care, NYU Grossman School of Medicine, New York, New York.
| | - Ariane Lewis
- Department of Neurology, Division of Neurocritical Care, NYU Grossman School of Medicine, New York, New York
| | - Les James
- Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, New York, New York
| | - Kara Melmed
- Department of Neurology, Division of Neurocritical Care, NYU Grossman School of Medicine, New York, New York
| | - Brendan Parent
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Eytan Raz
- Department of Radiology, Division of Neuroradiology, NYU Grossman School of Medicine, New York, New York
| | - Syed T Hussain
- Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, New York, New York
| | - Deane E Smith
- Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, New York, New York
| | - Nader Moazami
- Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, New York, New York
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Martínez-Castro S, Navarro R, García-Pérez ML, Segura JM, Carbonell JA, Hornero F, Guijarro J, Zaplana M, Bruño MÁ, Tur A, Martínez-León JB, Zaragoza R, Núñez J, Domínguez-Gil B, Badenes R. Evaluation of functional warm ischemia time during controlled donation after circulatory determination of death using normothermic regional perfusion (ECMO-TT): A prospective multicenter cohort study. Artif Organs 2023; 47:1371-1385. [PMID: 37042612 DOI: 10.1111/aor.14539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/29/2023] [Accepted: 04/06/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Controlled donation after circulatory determination of death (cDCD) seems an effective way to mitigate the critical shortage of available organs for transplant worldwide. As a recently developed procedure for organ retrieval, some questions remain unsolved such as the uncertainty regarding the effect of functional warm ischemia time (FWIT) on organs´ viability. METHODS We developed a multicenter prospective cohort study collecting all data from evaluated organs during cDCD from 2017 to 2020. All the procedures related to cDCD were performed with normothermic regional perfusion. The analysis included organ retrieval as endpoint and FWIT as exposure of interest. The effect of FWIT on the likelihood for organ retrieval was evaluated with Relative distribution analysis. RESULTS A total amount of 507 organs´ related information was analyzed from 95 organ donors. Median donor age was 62 years, and 63% of donors were male. Stroke was the most common diagnosis before withdrawal of life-sustaining therapy (61%), followed by anoxic encephalopathy (21%). This analysis showed that length of FWIT was inversely associated with organ retrieval rates for liver, kidneys, and pancreas. No statistically significant association was found for lungs. CONCLUSIONS Results showed an inverse association between functional warm ischemia time (FWIT) and retrieval rate. We also have postulated optimal FWIT's thresholds for organ retrieval. FWIT for liver retrieval remained between 6 and less than 11 min and in case of kidneys and pancreas, the optimal FWIT for retrieval was 6 to 12 min. These results could be valuable to improve organ utilization and for future analysis.
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Affiliation(s)
- Sara Martínez-Castro
- Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clínic Universitari de Valencia, Valencia, Spain
- INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Rosalía Navarro
- Department of Surgery, School of Medicine, University of Valencia, Valencia, Spain
| | - María Luisa García-Pérez
- Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clínic Universitari de Valencia, Valencia, Spain
- INCLIVA Biomedical Research Institute, Valencia, Spain
- Department of Surgery, School of Medicine, University of Valencia, Valencia, Spain
| | - José Manuel Segura
- Department of Medical Intensive Care, Hospital Clínic Universitari de Valencia, Valencia, Spain
- Transplant Coordination Unit, Hospital Clínic Universitari de Valencia, Valencia, Spain
| | - José A Carbonell
- Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clínic Universitari de Valencia, Valencia, Spain
- INCLIVA Biomedical Research Institute, Valencia, Spain
- Department of Surgery, School of Medicine, University of Valencia, Valencia, Spain
| | - Fernando Hornero
- Department of Cardiac Surgery, Hospital Clínic Universitari de Valencia, Valencia, Spain
| | - Jorge Guijarro
- Department of Interventional Radiology, Hospital Clínic Universitari de Valencia, Valencia, Spain
| | - Marta Zaplana
- Department of Vascular Surgery, Hospital Clínic Universitari de Valencia, Valencia, Spain
| | - María Ángeles Bruño
- Cardiovascular Perfussion Unit, Hospital Clínic Universitari de Valencia, Valencia, Spain
| | - Ana Tur
- Transplant Coordination Unit, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - Juan Bautista Martínez-León
- Department of Surgery, School of Medicine, University of Valencia, Valencia, Spain
- Department of Cardiac Surgery, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - Rafael Zaragoza
- Department of Intensive Care Medicine, Hospital Universitario Dr. Peset, Valencia, Spain
| | - Julio Núñez
- INCLIVA Biomedical Research Institute, Valencia, Spain
- Department of Cardiology, Hospital Clínic Universitari de Valencia, Valencia, Spain
- Department of Medicine. School of Medicine, University of Valencia, Valencia, Spain
| | | | - Rafael Badenes
- Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clínic Universitari de Valencia, Valencia, Spain
- INCLIVA Biomedical Research Institute, Valencia, Spain
- Department of Surgery, School of Medicine, University of Valencia, Valencia, Spain
- Transplant Coordination Unit, Hospital Clínic Universitari de Valencia, Valencia, Spain
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Zhou AL, Ruck JM, Casillan AJ, Larson EL, Shou BL, Karius AK, Ha JS, Shah PD, Merlo CA, Bush EL. Early United States experience with lung donation after circulatory death using thoracoabdominal normothermic regional perfusion. J Heart Lung Transplant 2023; 42:693-696. [PMID: 36990867 PMCID: PMC10192114 DOI: 10.1016/j.healun.2023.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/10/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023] Open
Abstract
Thoracoabdominal normothermic regional perfusion (TA-NRP) has recently begun being utilized in the United States for recovery of cardiothoracic allografts from some donors after circulatory death (DCD), but data on lungs recovered in this method is limited to case reports. We conducted a national retrospective review of lung transplants from DCD donors recovered using TA-NRP. Of the 434 total DCD lung transplants performed between January 2020 and March 2022, 17 were recovered using TA-NRP. Compared to direct recovery DCD transplants, recipients of TA-NRP DCD transplants had lower likelihood of ventilation >48 hours (23.5% vs 51.3%, p = 0.027) and similar likelihood of predischarge acute rejection, requirement for extracorporeal membrane oxygenation at 72 hours, hospital lengths of stay, and survival at 30, 60, and 90 days post-transplant. These early data suggest that DCD lung recovery using TA-NRP might be a safe way to further expand the donor pool and warrant further study.
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Affiliation(s)
- Alice L Zhou
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Jessica M Ruck
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Alfred J Casillan
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Emily L Larson
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Benjamin L Shou
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Alexander K Karius
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Jinny S Ha
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Pali D Shah
- Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Christian A Merlo
- Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Errol L Bush
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
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15
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Egan TM, Requard JJ. Ethics of Normothermic Regional Perfusion for Donors and Definition of Death. Chest 2023; 163:e248-e249. [PMID: 37164593 DOI: 10.1016/j.chest.2022.11.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 11/23/2022] [Indexed: 05/12/2023] Open
Affiliation(s)
- Thomas M Egan
- Departments of Surgery and Biomedical Engineering, Division of Cardiothoracic Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lung Banks of America, Durham, NC.
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16
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DeCamp M, Fins JJ, Sulmasy LS. Response. Chest 2023; 163:e249-e250. [PMID: 37164594 DOI: 10.1016/j.chest.2023.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 05/12/2023] Open
Affiliation(s)
- Matthew DeCamp
- Center for Bioethics and Humanities & Division of General Internal Medicine, University of Colorado, Aurora, CO.
| | - Joseph J Fins
- Division of Medical Ethics, Weill Cornell Medical College, New York, NY; Solomon Center for Health Law & Policy, Yale Law School, New Haven, CT
| | - Lois Snyder Sulmasy
- Center for Ethics and Professionalism, American College of Physicians, Philadelphia, PA
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Peled H, Matthews S, Rhodes D, Bernat J. The authors reply. Crit Care Med 2023; 51:e96-e97. [PMID: 36928018 DOI: 10.1097/ccm.0000000000005803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Harry Peled
- Providence Saint Jude Medical Center, Fullerton, CA
| | | | - David Rhodes
- Providence Saint Jude Medical Center, Fullerton, CA
| | - James Bernat
- Department of Neurology, Dartmouth Geisel School of Medicine, Hanover, NH
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18
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Courtwright AM. Normothermic Regional Perfusion, Causes, and the Dead Donor Rule. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:46-47. [PMID: 36681910 DOI: 10.1080/15265161.2022.2159571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
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19
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James L, Parent B, Moazami N, Smith DE. Rebuttal From Dr James et al. Chest 2022; 162:293-294. [PMID: 35940654 DOI: 10.1016/j.chest.2022.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/08/2022] [Indexed: 10/16/2022] Open
Affiliation(s)
- Les James
- Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, New York, NY
| | - Brendan Parent
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Nader Moazami
- Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, New York, NY; Division of Heart and Lung Transplantation and Mechanical Circulatory Support, NYU Grossman School of Medicine, New York, NY.
| | - Deane E Smith
- Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, New York, NY; Division of Heart and Lung Transplantation and Mechanical Circulatory Support, NYU Grossman School of Medicine, New York, NY
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