Normothermic Regional Perfusion with Controlled Donation after Circulatory Death: Philosophical Worries

Abstract: Recently the medical establishment has seen the implantation of a new procedure: transplant surgeons are allowing terminal patients to die, then restarting their hearts while clamping off blood flow to their brains. This procedure, called as “normothermic regional perfusion with controlled donation after circulatory death” (NRP-cDCD), allows surgeons to remove organs for donation from bodies with heartbeats. My aim in this paper to examine two philosophical worries pertaining to NRP-cDCD. The first worry is a conceptual one: how are we to understand what is happening during the procedure? We are familiar with following scenarios: (a) a patient whose heart stops and is resuscitated, and (b) a patient whose heart stops and is not resuscitated because they are DNR. NRP-cDCD is a kin to scenario (a) in that the patient is resuscitated—their hears are restarted—but is different in that the patient is considered deceased. NRP-cDCD is a different from scenario (b) in that the patient is resuscitated but is a kin to it in that the patient is nevertheless considered deceased. So what we want is for consent to NRP-cDCD to look something like consent to DNR but with resuscitation. I discuss the conceptual challenges to this suggestion. The second worry pertains to the question of whether physicians qua physicians should be engaged in NRP-cDCD. In particular, I examine whether engaging in NRP-cDCD contradicts the ends of medicine and physician obligations. (Among other things, the surgeon, in such cases, induces brain death when it is not medically indicated.)