Normothermic regional perfusion (NRP) has recently been used to augment organ donation after circulatory death (DCD) to improve the quantity and quality of transplantable organs. In DCD-NRP, after withdrawal of life-sustaining therapies and cardiopulmonary arrest, patients are cannulated onto extracorporeal membrane oxygenation to reestablish blood flow to targeted organs including the heart. During this process, aortic arch vessels are ligated to restrict cerebral blood flow. We review ethical challenges including whether the brain is sufficiently reperfused through collateral circulation to allow reemergence of consciousness or pain perception, whether resumption of cardiac activity nullifies the patient's prior death determination, and whether specific authorization for DCD-NRP is required. ANN NEUROL 2024;95:1035–1039

中文翻译：

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超越最后的心跳：循环死亡后器官捐赠的常温局部灌注的神经学观点


常温局部灌注（NRP）最近已被用于增强循环死亡后器官捐献（DCD），以提高可移植器官的数量和质量。在 DCD-NRP 中，在停止生命维持治疗和心肺骤停后，患者被插管进行体外膜氧合，以重新建立流向包括心脏在内的目标器官的血流。在此过程中，主动脉弓血管被结扎以限制脑血流。我们回顾了伦理挑战，包括大脑是否通过侧支循环得到充分再灌注，以允许意识或疼痛感知重新出现，心脏活动的恢复是否会使患者之前的死亡判定无效，以及是否需要 DCD-NRP 的特别授权。安神经学 2024 年；95：1035–1039