"Over the last decade, a novel method of organ donation after circulatory death (DCD) known as normothermic regional perfusion (NRP) has come into widespread use in various European countries. Although DCD is well established in the U.S., NRP has generated significant controversy, and the American College of Physicians (ACP) has issued a statement recommending a freeze on its implementation until outstanding ethical concerns are more thoroughly resolved. At the center of the controversy is the contention that NRP kills the donor."
"In its "controlled" form (cDCD), donation after circulatory death follows a request by a patient with a do-not-resuscitate order (DNR) or a surrogate decision-maker for such a patient to withdraw life-sustaining treatments (LSTs) due to a poor prognosis. Once LSTs are withdrawn and the patient sustains cardiac arrest, physicians wait for five minutes before declaring the patient dead based on circulatory criteria. In "standard" cDCD, surgeons rapidly retrieve organs and place them in cold storage."
Normothermic regional perfusion (NRP) reestablishes circulation to thoracic and abdominal organs after circulatory death while occluding the arteries supplying the brain to prevent cerebral reperfusion. Controlled donation after circulatory death (cDCD) involves withdrawal of life-sustaining treatments, followed by a five-minute hands-off period after cardiac arrest before death is declared by circulatory criteria. The hands-off period causes ischemic damage to organs. Alternatives include ex situ normothermic machine perfusion (NMP) and in situ NRP; both reverse ischemic injury, while NRP uses ECMO-based regional reperfusion and offers advantages in organ assessment and recovery.
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