International Controversies over ta-NRP for Organ Procurement: Brain Perfusion and the Dead Donor Rule

Neuroethics 2025
Full schedule
Registration

This panel will explore experiences of and concerns about Thoracoabdominal normothermic regional perfusion (ta-NRP) in different cultural and legal contexts. Experts will identify and critique different conceptions of the role of the brain in informing perspectives on the permissibility of ta-NRP, as well as discuss how national professional and public norms around the brain affect views of this controversial procedure.

Speakers:

This session is organized by members of the Clinical Neuroethics Affinity Group.

Attend

Neuroethics 2025
Munich, Germany + virtual

Thursday, April 24, 2025
2:30-3:30pm CEST

This discussion is being held as part of Neuroethics 2025, the joint annual meeting of the International Neuroethics Society (INS) and Società Italiana di Neuroetica (SINe). Register for the conference to see this session in-person in Munich or to participate virtually. Virtual participants can watch the live broadcast and submit questions to the discussion. All registrants will get access to the recordings before the general public.

Registration

Description

In response to the inadequate supply of organs for transplantation, surgeons are adopting novel techniques to procure organs that previously would have been unsuitable for transplantation. Thoracoabdominal normothermic regional perfusion (ta-NRP) is one technique that has been adopted internationally yet is ethically controversial. In ta-NRP, following declaration of circulatory death, thoracic and abdominal organs are artificially reperfused in situ, while brain perfusion is surgically prevented. Ta-NRP is performed in Spain, Italy, the Netherlands, France, and some centers in the United States, but is presently contrary to guidelines in Canada, Australia, and New Zealand. The UK and Belgium have halted the practice pending further study. Various national professional societies have opposed ta-NRP, arguing that it violates the dead donor rule. Meanwhile, advocates have argued that ta-NRP is an ethically unproblematic and cost-effective method for improving the quality and quantity of organs. Scholars also disagree about whether brain perfusion is sufficiently prevented by current protocols and whether such prevention is ethically necessary.

Given such controversies and variations in practice, we propose an international panel of experts to explore experiences of and concerns about ta-NRP in different cultural and legal contexts. This panel aims not merely to compare different national practices, but to identify and critique different conceptions of the role of the brain in informing perspectives on the permissibility of ta-NRP; e.g., in various national statutory definitions of death and their divergent interpretations of the brain’s role in circulatory death. Moreover, panelists will consider how national professional and public norms around the brain affect views of this controversial procedure.  

Our proposed panel represents diverse international and disciplinary perspectives. The panel will be moderated by Karola Kreitmair, a US-based philosopher-bioethicist who will also present on the fragmented adoption of ta-NRP in the US. Amelia Hessheimer, a hepatopancreaticobiliary and transplant surgeon practicing in Spain, will present on experiences from Spain where ta-NRP has been enthusiastically adopted. Alex Manara, a UK-based critical care physician, will present on experiences in the UK, where ta-NRP has been paused.

Resources

References

  1. Kreitmair KV. On the ethical permissibility of in situ reperfusion in cardiac transplantation after the declaration of circulatory death. J Med Ethics. 2023 Aug 4:jme-2022-108819. doi: 10.1136/jme-2022-108819. Epub ahead of print. PMID: 37541783.
  2. Jochmans I, Hessheimer AJ, Neyrinck AP, Paredes D, Bellini MI, Dark JH, Kimenai HJAN, Pengel LHM, Watson CJE; ESOT Workstream 04 of the TLJ (Transplant Learning Journey) project. Consensus statement on normothermic regional perfusion in donation after circulatory death: Report from the European Society for Organ Transplantation’s Transplant Learning Journey. Transpl Int. 2021 Nov;34(11):2019-2030. doi: 10.1111/tri.13951. PMID: 34145644.
  3. Manara A, Shemie SD, Large S, Healey A, Baker A, Badiwala M, Berman M, Butler AJ, Chaudhury P, Dark J, Forsythe J, Freed DH, Gardiner D, Harvey D, Hornby L, MacLean J, Messer S, Oniscu GC, Simpson C, Teitelbaum J, Torrance S, Wilson LC, Watson CJE. Maintaining the permanence principle for death during in situ normothermic regional perfusion for donation after circulatory death organ recovery: A United Kingdom and Canadian proposal. Am J Transplant. 2020 Aug;20(8):2017-2025. doi: 10.1111/ajt.15775. Epub 2020 Jan 27. PMID: 31922653; PMCID: PMC7540256

Speakers

Moderator / Discussant

Karola Kreitmair, MSc, PhD

University of Wisconsin–Madison

Dr. Kreitmair is an Associate Professor at the University of Wisconsin School of Medicine and Public Health, Co-Director of the Path of Distinction in Bioethics program, and Vice-Chair of the Hospital Ethics Committee. Her work involves clinical ethics (e.g., the determination of death), research ethics (e.g., the moral status of human brain surrogates, such as brain organoids), and consumer bioethics (e.g., the implications of digital behavioral technology, such as self-tracking). She recently published a philosophical argument regarding the ethical permissibility of ta-NRP (Kreitmair, 2023). Profile / Disclosures: None


Discussants

Amelia Hessheimer, MD, PhD

Hospital Universitario La Paz, Madrid

Dr. Hessheimer is a Hepatopancreatobiliary (HPB) & Transplant Surgery Specialist at Hospital Universitario La Paz in Madrid. Her research interests include liver regeneration, ischemia-reperfusion injury, and organ preservation. She has published extensively on these topics and has received numerous awards, including the 2020 National Surgery Award from the Spanish Society of Surgeons. Dr. Hessheimer has recently co-authored the European Soceity for Organ Transplantation’s consensus statement on NRP (Jochmans et al., 2021). / LinkedIn

Disclosures: The author(s) discloses past research funding from Guanguong Shunde Innovative Design Institute, current research funding from Instituto de Salud Carlos III, and a speaker honoraria from Astellas and XVIVO.

Alex Manara, MB, BCh

North Bristol NHS Trust

Dr. Manara is a Consultant in Intensive Care Medicine. He has over 30 years of experience in this setting, involving contributing to national/international guidance on death determination and organ donation (e.g., contributed to the Academy of Medical Royal Colleges’ guidelines on death diagnosis and UK’s first controlled DCD program). Dr. Manara has served as the National Quality Lead for Organ Donation and recently authored an influential early analysis of the compatibility of ta-NRP with the dead donor rule (Manara et al., 2020). Profile / Disclosures: None

Organizers

Winston Chiong, MD, PhD

UCSF / UCSF Bioethics

Dr. Chiong is an Professor of Neuroethics at UCSF and Director of UCSF Bioethics. His clinical work focuses on Alzheimer’s, frontotemporal dementia, and cognitive disorders of aging. His research explores decision-making in the aging brain and the ethical and policy impacts of brain function changes. Dr. Chiong serves on the NIH BRAIN Neuroethics Working Group, the American Academy of Neurology’s Ethics Committee, and the Board of the International Neuroethics Society. Profile / Disclosure: None

Diana Urian, MSc Candidate, BSc

University of Ottawa

Ms. Urian is a recent Neuroscience graduate from Western University. She is pursuing an MSc at uOttawa, under the supervision of Jennifer Chandler. Her research explores whether existing Canadian law is adequately equipped to handle privacy concerns of emerging neurotechnology. Following this, she aspires to go to law school and pursue a career in healthcare law, with a long-term goal of becoming a university professor. Her interests include cognitive neuroscience, ethics, philosophy, law, and education. Profile / Disclosures: None

Matthew L. Baum, MD, PhD, DPhil

Brigham and Women’s Hospital and Harvard Medical School

Dr. Baum is an Attending Physician at Brigham and Women’s Hospital and Harvard Medical School. He focuses on immune-molecule dysfunction in psychosis and mood disorders and is launching an immune psychiatry consultation service for autoimmune-related psychiatric symptoms. As the inaugural Director of the Translational Neuroimmune Psychiatry Research Program, he will lead research on novel autoantibody biomarkers. He also teaches neuroethics and authored The Neuroethics of Biomarkers (Oxford University Press). Profile / Disclosures: None

|