{
  "abstract": "Heart transplantation remains the gold standard of treatment for end-stage cardiovascular disease, but there is a persistent mismatch between the supply of donor hearts and recipient demand. Thoracoabdominal normothermic perfusion (TA-NRP) could narrow this gap by improving the quality of hearts procured by donation after circulatory death. During TA-NRP, circulation is restored to the thoracic and abdominal organs after death is declared, while blood flow to the brain is blocked to maintain compatibility with the dead donor rule. However, this sequence creates a complex bioethical tension, as donors transition between definitions of living and deceased during TA-NRP procurement. Moreover, concerns have been raised that current TA-NRP techniques do not fully prevent cerebral blood flow and brain function during reperfusion. In-depth neuromonitoring studies are necessary to confirm the bioethical viability of TA-NRP, but existing research ethics frameworks do not neatly apply to TA-NRP studies; in TA-NRP, donors move between categories of ‘living’ and ‘dead’ and may simultaneously be considered both research participants and organ donors. Thus, regulation of TA-NRP research must consider bioethical principles of both living-participant research and research on the recently deceased. In this perspective, we describe TA-NRP as an organ procurement method, address the primary bioethical concerns with TA-NRP and highlight ethical issues relevant for research on the neurological physiology of TA-NRP. Finally, we propose preliminary structures of regulation and informed consent to facilitate ethical research and development of TA-NRP to protect donors and families while maintaining consistency with the Uniform Determination of Death Act.",
  "authors": [
    {
      "affiliations": [
        "NYU Grossman School of Medicine, New York, New York, USA"
      ],
      "name": "Justin Tao Wang"
    },
    {
      "affiliations": [
        "Population Health, NYU Langone Health, New York, New York, USA"
      ],
      "name": "Brendan Parent"
    }
  ],
  "title": "Developing bioethical and regulatory frameworks for research in thoracoabdominal normothermic regional perfusion",
  "uid": "6789e6be-b58c-549d-aa54-2feda9ddedda"
}