The U.S. organ transplant system has approved the first national policy for a controversial procedure used to recover organs from hospital patients, NPR reported. The procedure is called normothermic regional perfusion, or NRP. It can be used after a family has decided to withdraw care because there is no hope of a meaningful recovery. Minutes after circulation has ended and the patient has been declared dead, doctors attach an external pump that restores blood flow to the heart, lungs, kidneys, liver and other organs so they do not deteriorate. "The hope with NRP is that it increases the supply of organs and it increases the quality of the organs," said Dr. Raymond Lynch, director of transplantation at the Health Resources and Services Administration, which oversees the system. More than 109,000 Americans are waiting for a transplant, according to HRSA, and about 12 die every day because of the shortage.
Critics say NRP violates the Dead Donor Rule, which holds that transplant surgeons may take organs only after a patient is dead and that the recovery itself must not cause death. "In order to be dead by circulatory criteria it means we're not going to attempt to reestablish circulation. But that's exactly what they do in NRP," said Dr. Lainie Friedman Ross, a University of Rochester bioethicist. Surgeons also clamp blood vessels that supply the head, trying to ensure the donor is brain-dead once the pump restarts circulation. Dr. Claire Morgan, a transplant surgeon on the network's Patient Affairs Committee, was the first to report to HRSA that "we have seen signs of life in NRP when the brain has been reperfused." Those cases led HRSA to instruct the Organ Procurement and Transplantation Network to investigate.
On Nov. 6, the OPTN board approved the first phase of a national policy, which takes effect Dec. 6. The guidelines say surgeons should do more than clamp the vessels to the brain: they should also cut holes in them. "Clamping the blood vessels should stop blood flowing to the brain," Lynch said. "Cutting or venting above the level of the clamping is a second safeguard to make sure that if the clamping is insufficient that it immediately drains out." Critics say the safeguards are not enough, and that most surgeons already both clamp and vent. The new rules, they argue, do little to improve safety or answer the ethical objection that circulation is being restarted in a person declared dead.
The verified news is a national policy with a December start date, not a settlement of the ethical dispute and not a guarantee that NRP will close the waiting-list gap. Lynch presents it as a way to obtain more, better organs. Ross, Morgan and other critics say the central rule that protects donors is still in question.