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The outcome case for regional perfusion is strong and the technique uses the same hardware an ECMO unit already owns. The ethical question is separate and unresolved: a 71-document scoping review found no agreement on its permissibility, and the arch-vessel ligation that prevents cerebral reperfusion is the whole ethical architecture expressed as a surgical step.
Conventional rapid recovery without regional perfusion
DOI 10.1097/tp.0000000000004280
In situ normothermic regional perfusion before procurement
Registry, retrospective, controlled donors only - not the uncontrolled pathway that follows a failed ECPR run. Structured abstract only. [VERIFICATION REQUIRED]
3.3 organs transplanted per donor with regional perfusion against 2.6 without. Adjusted odds of the organ being transplanted rose roughly threefold for liver (P below 0.0001; 95% CI 2.20-4.29), 1.5-fold for kidney (P = 0.12; 0.87-2.58) and 1.6-fold for pancreas (P = 0.0611; 0.98-2.64). Twelve-month liver graft survival was superior, with a 51% lower risk-adjusted hazard of transplant failure (HR 0.494). Kidneys had a 35% lower chance of delayed graft function (OR 0.65, 0.465-0.901) and an expected 12-month eGFR 6.3 mL/min/1.73 m2 better.
UK adult controlled circulatory-death donors with at least one abdominal organ accepted for transplantation, 2011-2019