An emerging method to retrieve hearts from organ donors has the potential to significantly expand the number of hearts available for patients awaiting transplant. However, not all hospitals are on board, with many experts citing ethical and legal concerns about the definitions of life and death, The New York Times reported Nov. 22.
Typically, donor hearts come from a small pool of donors who are declared brain dead but remain on life support. The new method, known as normothermic regional perfusion, expands the potential donor pool to include patients who are comatose, though not brain dead. The technique involves using a cardiopulmonary bypass machine to restore blood flow to the heart in comatose patients whose families have withdrawn life support.
Because the procedure involves restarting blood flow after the heart and circulation have stopped, some ethicists and surgeons say it invalidates any previous declaration of death. Another part of the procedure sparking concern is the use of clamps to cut blood flow from the revived heart to the donor's head, which is done to limit the possibility that any trace of brain activity is restored when circulation is restarted.
The method was championed by New York City-based NYU Langone Health and has since been used to recover nearly 30 hearts. It was first performed in 2020, and Vanderbilt Medical Center in Nashville, Tenn., has also embraced the procedure. Meanwhile, NewYork-Presbyterian Hospital rejected it after an ethics committee review. The American College of Physicians also opposes it, saying it appears to violate "one of the ethical foundations of organ donation, the 'dead donor rule.'" The rule specifies organ retrieval must not cause death.
Many experts agree the technique would dramatically expand the number of available donor hearts, though some are uncomfortable with the ethical challenges it presents. Some have even suggested the technique may make surgeons vulnerable to prosecution.
In an interview with the Times, Nader Moazami, MD, a transplant surgeon who led the first procedure at NYU Langone, recognized the concerns and pointed to medicine's lack of full understanding about what happens to the brain after death. Much of the criticism, he says, comes from ethicists who don't spend time with patients stuck on organ transplant lists.
"You guys can sit in your offices worried about the ethics of something, but you've never had to walk into a room where you were facing a patient with a family who's dying, who's been waiting for an organ, and who is not going to get an organ," he told the news outlet. "If you've ever experienced that in your life, you will never tell me what I'm doing is unethical."