The field of transplant medicine is rapidly developing technologies to address the severe organ shortage. With the transplant system and organ procurement organizations under increasing congressional scrutiny to improve efficient use of organs, there are growing efforts to optimize use of transplantable organs coming from donors who have been declared dead by circulatory criteria. Unlike organs obtained from living or brain-dead donors, those procured from donations after circulatory death are often compromised by hypoxic-ischemic injury because they cannot be removed until the donor has been declared dead, which in the US is typically after the donor has been pulseless for 5 minutes. [JAMA Network]

Although multiple techniques have been developed to minimize or partially reverse the ischemic injury associated with donation after circulatory death, none has been as promising as normothermic regional perfusion. Although enthusiastically endorsed by many as an approach to procuring more and higher-quality organs, normothermic regional perfusion has also drawn criticism, including concerns that it may violate the “dead donor rule,” a fundamental ethical principle of organ procurement that prohibits procedures that may result in patients dying either by or for the procurement of their organs.

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