Organ Transplant Crisis & Mortality Rates - There are approximately 105,000 people on the national transplant waiting list in the United States [1] - The one-year mortality rate for those remaining on the transplant waiting list is 36%, and the five-year mortality rate is 69% [2] - Every day, 17 people die while awaiting transplants [3] Ethical Controversy of Normothermic Regional Perfusion - Normothermic regional perfusion (NRP) is ethically controversial due to the allegation that it kills the donor during organ retrieval [3][4] - The American College of Physicians recommends a freeze on NRP nationwide until ethical concerns are addressed [4] - The core objection alleges that clamping arteries leading to the brain during NRP causes brain death [7] Comparison of Normothermic Regional Perfusion (NRP) and Normothermic Machine Perfusion - In NRP, after the donor is declared dead based on circulatory criteria, arteries to the brain are blocked, and circulation is reinitiated in the chest and abdomen [6] - In normothermic machine perfusion, after the donor is declared dead, organs are flushed with cold preservation fluid and stored in a machine with oxygenated blood [10] - NRP allows monitoring of organ function within the donor's body and enables the harvesting of both the heart and liver from the same donor, advantages not typically seen with machine perfusion [12][13] Re-evaluation of the Ethical Objection - The argument that NRP kills the donor is questioned because donors are declared dead at the same time in both NRP and machine perfusion, using the same criteria [15] - The permanence criterion, which states death is defined by irreversible loss of circulation, is challenged as a basis for distinguishing between NRP and machine perfusion [17][19] - The speaker argues that if NRP kills donors, then machine perfusion must also, as both involve interventions after the declaration of death [23] Proposed Solution and Justification - The speaker suggests that the focus should be on the fact that donors have lost consciousness and expressed their wish not to be resuscitated before either procedure commences [25] - The procurement process should begin promptly to preserve organ viability and honor the donor's wishes [25] - Since circulation has ceased, blocking arteries or removing organs does not prevent blood from reaching the brain that would otherwise have reached it [26] - The medical community should approve of regional profusion, similar to machine profusion, as neither procedure causes death any sooner than it would otherwise [27]