Beyond the Final Heartbeat: Neurological Perspectives on Normothermic Regional Perfusion for Organ Donation after Circulatory Death.
Matthew P KirschenAriane LewisMichael A RubinPanayiotis N VarelasDavid M GreerPublished in: Annals of neurology (2024)
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.
Keyphrases
- extracorporeal membrane oxygenation
- blood flow
- acute respiratory distress syndrome
- cerebral blood flow
- end stage renal disease
- ejection fraction
- newly diagnosed
- respiratory failure
- chronic pain
- heart failure
- chronic kidney disease
- contrast enhanced
- prognostic factors
- left ventricular
- magnetic resonance imaging
- pain management
- peritoneal dialysis
- case report
- cell cycle
- cerebral ischemia
- mechanical ventilation
- neuropathic pain
- resting state
- atrial fibrillation
- solid phase extraction
- computed tomography
- decision making
- patient reported outcomes
- postoperative pain
- blood brain barrier
- functional connectivity
- patient reported
- tandem mass spectrometry