In Defense of Normothermic Regional Perfusion

IF 2.3 3区 哲学 Q1 ETHICS
Robert D. Truog, Samuel N. Doernberg
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引用次数: 0

Abstract

Normothermic regional perfusion (NRP) is a relatively new approach to procuring organs for transplantation. After circulatory death is declared, perfusion is restored to either the thoracoabdominal organs (in TA-NRP) or abdominal organs alone (in A-NRP) using extracorporeal membrane oxygenation. Simultaneously, surgeons clamp the cerebral arteries, causing a fatal brain injury. Critics claim that clamping the arteries is the proximate cause of death in violation of the dead donor rule and that the procedure is therefore unethical. We disagree. This account does not consider the myriad other factors that contribute to the death of the donor, including the presence of a fatal medical condition, the decision to withdraw life support, and the physician's actions in withdrawing life support and administering medication that may hasten death. Instead, we claim that physicians play a causative role in many of the events that lead to a patient's death and that these actions are often ethically and legally justified. We advance an “all things considered” view according to which TA-NRP may be considered ethically acceptable insofar as it avoids suffering and respects the wishes of the patient to improve the lives of others through organ donation. We conclude with a series of critical questions related to the practice of NRP and call for the development of national consensus on this issue in the United States.

捍卫常温区域灌注。
常温区域灌注(NRP)是一种相对较新的器官移植方法。在宣布循环死亡后,利用体外膜氧合恢复胸腹器官(TA-NRP)或腹腔器官(A-NRP)的灌注。与此同时,外科医生钳夹脑动脉,造成致命的脑损伤。批评者认为,钳夹动脉是导致死亡的直接原因,违反了死亡捐献者规则,因此该手术是不道德的。我们不敢苟同。这种说法没有考虑到导致捐献者死亡的其他众多因素,包括致命疾病的存在、撤除生命维持系统的决定以及医生撤除生命维持系统和使用可能加速死亡的药物的行为。相反,我们认为医生在许多导致病人死亡的事件中扮演了因果角色,而这些行为在伦理和法律上往往是合理的。我们提出了一种 "全面考虑 "的观点,根据这种观点,TA-NRP 在伦理上是可以接受的,因为它可以避免痛苦,并尊重病人通过器官捐赠改善他人生活的愿望。最后,我们提出了一系列与 NRP 实践相关的关键问题,并呼吁美国就此问题达成全国共识。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Hastings Center Report
Hastings Center Report 医学-卫生保健
CiteScore
3.50
自引率
3.00%
发文量
99
审稿时长
6-12 weeks
期刊介绍: The Hastings Center Report explores ethical, legal, and social issues in medicine, health care, public health, and the life sciences. Six issues per year offer articles, essays, case studies of bioethical problems, columns on law and policy, caregivers’ stories, peer-reviewed scholarly articles, and book reviews. Authors come from an assortment of professions and academic disciplines and express a range of perspectives and political opinions. The Report’s readership includes physicians, nurses, scholars, administrators, social workers, health lawyers, and others.
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