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Paper Presentation

Clinical Ethics

Session: Organ Procurement

An Ethics-Led Process for Considering Normothermic Regional Perfusion in Pediatrics

Friday, October 24, 2025
1:15 PM - 2:15 PM Pacific Time
Location: C120-122
Rupali Gandhi, MD, JD, HEC-C – Director, Pediatric Ethics Advisory Committee & Director, Pediatric Cardiology Fellowship Program, Advocate Children's Hospital; Eliza Leatherberry, MDiv, BCC – Pediatric Staff Chaplain & Pediatric Bereavement Coordinator, Advocate Children's Hospital; Joanne Claveria, MD – Pediatric Intensivist & Associate Program Director, Pediatric Critical Care Medicine Fellowship, Advocate Children's Hospital
Abstract: Transplant teams and Organ Procurement Organizations (OPOs) across the nation are actively pursuing normothermic regional perfusion (NRP) in both adults and pediatrics. NRP restores circulation during organ procurement after circulatory death, and many bioethicists are concerned that perfusion could be restored to the brain during NRP through collateral circulation in violation of what is known as the Dead Donor Rule. Our Children’s Hospital ethics group has engaged in a deliberate process with hospital administration and our regional OPO regarding the use of NRP in pediatrics. In January of 2024, our ethics committee began analysis of NRP to provide a recommendation to hospital administration about whether to permit it. The committee met with a multidisciplinary group including surgeons, chaplains and hospital administrators. At that time, we recommended that our hospital not allow any type of NRP due to concerns about reperfusion, community and equity impacts, challenges with informed consent, and the vulnerability of pediatric populations. One year later, the regional OPO has decided to make abdominal-NRP standard in DCD organ procurements and pursue thoracic-abdominal-NRP in some cases. We have proactively engaged in a discussion with representatives from the OPO to express our concerns with NRP specifically as it applies to children. Through active and ongoing discussions, improved data regarding community engagement and informed consent, we hope to find consensus moving forward. Our example of a deliberate process may be useful to other children’s hospitals facing the same pressure from their OPO to adopt NRP.

Keywords: Normothermic Regional Perfusion, Pediatrics, Organ Procurement

Learning Objectives:

After participating in this conference, attendees should be able to:
  • Understand the two different types of Normothermic Regional Perfusion (NRP): Abdominal and Thoraco-Abdominal.
  • Analyze the ethical arguments in favor and against NRP both broadly and specifically with regard to pediatric populations.
  • Develop a deliberate process to work with Organ Procurement Organization(s) to express ethical concerns with NRP and explore consensus paths forward.