Does normothermic regional perfusion harm donors after circulatory death?

Abstract

Normothermic regional perfusion during controlled donation after circulatory death has emerged as a means to increase the number and viability of organs available for transplant. Because normothermic regional perfusion uses extracorporeal membrane oxygenation, an intervention used for resuscitation under other circumstances, critics have concluded that organ donation using normothermic regional perfusion violates the dead donor rule. As such, the debate about normothermic regional perfusion has been framed as a binary choice between normothermic regional perfusion and the dead donor rule. In this paper, I argue that we should resist this binary framework and instead judge the permissibility of normothermic regional perfusion based on whether it harms organ donors. The obligations owed to organ donors derive from their moral status and include the obligation to prevent harm to donors, protect futures of value and satisfy donors' critical interests. When performed correctly, normothermic regional perfusion does not violate these moral obligations. Therefore, normothermic regional perfusion does not harm organ donors during controlled donation after circulatory death, making it ethically permissible when performed in accordance with standardised protocols.