Restart, reanimate, resurrect: exploring language of reperfusion in normothermic regional perfusion for organ donation after circulatory death

Abstract: Normothermic regional perfusion (NRP), extracorporeal technology used to circulate oxygenated blood through an organ donor’s body after declaration of death by circulatory criteria, has proven ethically challenging for hospital systems. Major ethical issues include the consent process for donor families, the permanence of death with recirculation, and clamping of vessels to prevent blood flow to the brain. This paper explores the language of organ support in NRP-DCD, noting a trend towards use of the term “reanimation” to describe organ function (i.e. the heart starting to beat again after extracorporeal flow is established) in the scientific literature. I contend that the language of reanimation shares an emotional tenor with resurrection, thereby blurring the lines of physiology and theology, even in academic discussions of the subject. Both in intellectual debate regarding the ethics of NRP-DCD and in the complex realities of consenting donor surrogates, it is critical to reach consensus about the language of organ support. I propose a return to physiologic terminology rather than continued use of “reanimation” to circumvent the associated theological and philosophical connotations.

Keywords: Normothermic regional perfusion, Organ procurement, Death and dying