Controlled heart donation after circulatory determination of death (cDCD) is well established internationally with good outcomes and could be adopted in the United States to increase heart supply if ethical and logistical challenges are comprehensively addressed. The most effective and resource-efficient method for mitigating warm ischemia after circulatory arrest is normothermic regional perfusion (NRP) in situ. This strategy requires restarting circulation after declaration of death according to circulatory criteria, which appears to challenge the legal circulatory death definition requiring irreversible cessation. Permanent cessation for life-saving efforts must be achieved to assuage this concern and ligating principal vessels maintains no blood flow to the brain, which ensures natural progression to cessation of brain function. This practice-standard in some countries-raises unique concerns about prioritizing life-saving efforts, informed authorization from decision-makers, and the clinician's role in the patient's death. To preserve public trust, medical integrity, and respect for the donor, the donation conversation must not take place until after an un-coerced decision to withdraw life-sustaining treatment made in accordance with the patient's treatment goals. The decision-maker(s) must understand cDCD procedure well enough to provide genuine authorization and the preservation/procurement teams must be kept separate from the clinical care team.

中文翻译：

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在美国建立 NRP-cDCD 心脏移植的伦理和后勤问题。

循环死亡后控制性心脏捐献 (cDCD) 在国际上已经确立并取得了良好的效果，如果伦理和后勤方面的挑战得到全面解决，可以在美国采用以增加心脏供应。缓解停循环后热缺血的最有效和资源效率最高的方法是原位常温区域灌注 (NRP)。该策略要求在根据循环标准宣布死亡后重新开始循环，这似乎挑战了要求不可逆停止的法定循环死亡定义。必须实现永久停止以挽救生命，以缓解这种担忧，并且结扎主要血管可以防止血液流向大脑，从而确保自然进展到大脑功能停止。这种在某些国家/地区的实践标准引起了对优先考虑拯救生命的努力、决策者的知情授权以及临床医生在患者死亡中的作用的独特关注。为了维护公众的信任、医疗诚信和对捐赠者的尊重，捐赠谈话必须在根据患者的治疗目标作出非强制性的撤回生命维持治疗的决定后才能进行。决策者必须充分了解 cDCD 程序以提供真正的授权，并且保存/采购团队必须与临床护理团队分开。为了医疗诚信和对捐赠者的尊重，在根据患者的治疗目标做出非强制性的撤回生命维持治疗的决定之前，不得进行捐赠谈话。决策者必须充分了解 cDCD 程序以提供真正的授权，并且保存/采购团队必须与临床护理团队分开。为了医疗诚信和对捐赠者的尊重，在根据患者的治疗目标做出非强制性的撤回生命维持治疗的决定之前，不得进行捐赠谈话。决策者必须充分了解 cDCD 程序以提供真正的授权，并且保存/采购团队必须与临床护理团队分开。