Knowledge gaps in heart and lung donation after the circulatory determination of death: Report of a workshop of the National Heart, Lung, and Blood Institute

J Heart Lung Transplant. 2024 Jun;43(6):1021-1029. doi: 10.1016/j.healun.2024.02.1455. Epub 2024 Mar 2.

Abstract

In a workshop sponsored by the U.S. National Heart, Lung, and Blood Institute, experts identified current knowledge gaps and research opportunities in the scientific, conceptual, and ethical understanding of organ donation after the circulatory determination of death and its technologies. To minimize organ injury from warm ischemia and produce better recipient outcomes, innovative techniques to perfuse and oxygenate organs postmortem in situ, such as thoracoabdominal normothermic regional perfusion, are being implemented in several medical centers in the US and elsewhere. These technologies have improved organ outcomes but have raised ethical and legal questions. Re-establishing donor circulation postmortem can be viewed as invalidating the condition of permanent cessation of circulation on which the earlier death determination was made and clamping arch vessels to exclude brain circulation can be viewed as inducing brain death. Alternatively, TA-NRP can be viewed as localized in-situ organ perfusion, not whole-body resuscitation, that does not invalidate death determination. Further scientific, conceptual, and ethical studies, such as those identified in this workshop, can inform and help resolve controversies raised by this practice.

Keywords: Uniform Determination of Death Act; dead donor rule; normothermic regional perfusion; organ donation after the circulatory determination of death; unified brain-based determination of death.

MeSH terms

  • Death*
  • Heart Transplantation
  • Humans
  • Lung Transplantation
  • National Heart, Lung, and Blood Institute (U.S.)
  • Organ Preservation / methods
  • Tissue Donors
  • Tissue and Organ Procurement* / ethics
  • Tissue and Organ Procurement* / methods
  • United States