Revisiting the Bioethical Challenges of Normothermic Regional Perfusion (NRP) and changing landscape of life and death

Abstract: Advancements in medical science have transformed legal, religious, and cultural understanding of humanity, life, and death in unimagined ways. Normothermic Regional Perfusion (NRP) is an innovative medical technique that involves using a machine to pass oxygenated blood through organs in a person’s body following declaration of death and prior to organ procurement. This method gained prominence a couple of years ago and became recognized by proponents as a timely and less expensive alternative, compared to Machine perfusion and standard methods for meeting the growing demands of high-quality organs for transplantation, however, the peculiarities of NRP, especially for procuring the human heart, presents unique challenges. After declaration of death, a 5-minute “hands off” is observed before the surgical organ removal process is initiated. However, instead of removal, in NRP the dead patients are reintubated to restore oxygenated blood to the organs, to observe the organ’s functionality and reduce ischemic injury prior to surgical removal process. NRP for the human heart in Donation after Circulatory death (DCD) presents important bioethical challenges for medical practitioners and the public. While several studies have highlighted the benefits and ethical challenges of NRP, with the latter emphasizing the violation of the Dead Donor Rule, this proposal revisits three crucial ethical challenges vis-a-vis the contemporary understanding of life and death. It argues that for NRPs in DCD to become ethically acceptable, one key procedure must be reviewed, with an overhaul of existing oversights/regulatory frameworks, and full disclosure of NRP for the public/prospective donors' opinion, amongst others.

Keywords: NRP, Life and Death, Bioethical Challenges