24, 77
The ethics of regional perfusion are formally unresolved. A 2024 scoping review of 71 documents found no agreement on its ethical permissibility, across six debates including compatibility with the dead donor rule, harm to donors, consent requirements, stakeholder trust and justice. A neurological analysis raises three specific questions about collateral cerebral reperfusion, whether resumed cardiac activity nullifies the prior determination, and whether specific rather than general authorisation is required.
A unit contemplating this pathway should start from this document and from its own national framework rather than from outcome data alone. For the intensivist the role is front-loaded: complete the death determination properly, keep the determination and the donation approach structurally separate, and know in advance whether uncontrolled donation is permitted locally, what no-touch interval applies and who to telephone.
[VERIFICATION REQUIRED - the consensus document was NOT retrieved and no individual recommendation is quoted here or anywhere in Chapter 24.] A European Society for Organ Transplantation consensus document provides evidence-based recommendations on the use of normothermic regional perfusion in both uncontrolled and controlled donation after circulatory death, and sets out the minimal ethical, logistical and technical requirements that form the foundation of a safe and effective programme. It states that regional perfusion is a safe alternative to in situ cooling and rapid procurement.
Organ donation and regional perfusion after failed ECPR