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;95:1035-1039.
Keyphrases
- extracorporeal membrane oxygenation
- blood flow
- acute respiratory distress syndrome
- cerebral blood flow
- end stage renal disease
- respiratory failure
- newly diagnosed
- ejection fraction
- chronic pain
- heart failure
- prognostic factors
- white matter
- left ventricular
- pain management
- case report
- cell cycle
- resting state
- atrial fibrillation
- neuropathic pain
- intensive care unit
- functional connectivity
- multiple sclerosis
- blood brain barrier
- spinal cord injury
- decision making
- cell proliferation
- neural network
- simultaneous determination