Ethical Issues in Normothermic Regional Perfusion in Controlled Organ Donation After Determination of Death by Circulatory Criteria: A Scoping Review.

Autor:	Murphy NB; Department of Medicine and Philosophy, Western University, London, ON, Canada.; Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada., Slessarev M; Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.; Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada., Basmaji J; Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.; Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada., Blackstock L; Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.; Donor family partner, Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada., Blaszak M; Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada., Brahmania M; Division of Gastroenterology and Hepatology, University of Calgary, Cumming School of Medicine, Calgary, AB, Canada., Chandler JA; Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada., Dhanani S; Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.; Pediatric Intensive Care, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada., Gaulton M; University of Western Ontario Faculty of Law, London, ON, Canada., Gross JA; Department of Clinical and Organizational Ethics, University Health Network, Toronto, ON, Canada.; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada., Healey A; Ontario Health (Trillium Gift of Life Network), Toronto, ON, Canada.; Divisions of Emergency and Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada., Lingard L; Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.; Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada., Ott M; Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.; Faculty of Education, York University, Toronto, ON, Canada., Shemie SD; Division of Critical Care Medicine, Montreal Children's Hospital, McGill University, Montreal, QC, Canada.; System Development, Canadian Blood Services, Ottawa, ON, Canada., Weijer C; Department of Medicine and Philosophy, Western University, London, ON, Canada.; Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.; Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
Jazyk:	angličtina
Zdroj:	Transplantation [Transplantation] 2024 Aug 28. Date of Electronic Publication: 2024 Aug 28.
DOI:	10.1097/TP.0000000000005161
Abstrakt:	Normothermic regional perfusion (NRP) is a surgical technique that can improve the quality and number of organs recovered for donation after the determination of death by circulatory criteria. Despite its promise, adoption of NRP has been hindered because of unresolved ethical issues. To inform stakeholders, this scoping review provides an impartial overview of the major ethical controversies surrounding NRP. We undertook this review according to a modified 5-step methodology proposed by Arksey and O'Malley. Publications were retrieved through MEDLINE and Embase. Gray literature was sourced from Canadian organ donation organizations, English-language organ donation organization websites, and through our research networks. Three reviewers independently screened all documents for inclusion, extracted data, and participated in content analysis. Disagreements were resolved through consensus meetings. Seventy-one documents substantively engaging with ethical issues in NRP were included for full-text analysis. We identified 6 major themes encompassing a range of overlapping ethical debates: (1) the compatibility of NRP with the dead donor rule, the injunction that organ recovery cannot cause death, (2) the risk of donor harm posed by NRP, (3) uncertainties regarding consent requirements for NRP, (4) risks to stakeholder trust posed by NRP, (5) the implications of NRP for justice, and (6) NRP's potential to benefits of NRP for stakeholders. We found no agreement on the ethical permissibility of NRP. However, some debates may be resolved through additional empirical study. As decision-makers contemplate the adoption of NRP, it is critical to address the ethical issues facing the technique to ensure stakeholder trust in deceased donation and transplantation systems is preserved. Competing Interests: J.A.G. holds a New Frontiers in Research Fund Transformation Grant to pursue clinical and research opportunities presented by ex vivo organ perfusion platforms. C.W. receives consulting income from Cardialen, Eli Lilly & Company, and Research Triangle Institute International. M.S. receives a stipend for his work as the Regional Medical Lead (Donation) with Ontario Health—Trillium Gift of Life Network. He also holds peer-reviewed research grants from the New Frontiers in Research Fund and the Canadian Institute of Health Research to study neurologic function during the dying process to inform deceased donation practices. A.H. receives a stipend for his work as the Provincial Medical Director, Organ and Tissue Donation with Ontario Health—Trillium Gift of Life Network. The other authors declare no conflicts of interest. (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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