American College of Physicians says organ procurement method raises significant ethical concerns

Lifestyle

The American College of Physicians (ACP) today issued a statement of concern about an organ procurement method for transplantation, normothermic regional perfusion with controlled donation after circulatory determination of death (NRP-cDCD), and is recommending a pause in the use of the practice.

NRP-cDCD has been used in a few other countries and is proposed for use in the U.S. for transplantation of organs such as the heart and intestines. In NRP-cDCD, extracorporeal membrane oxygenation (ECMO), cardiopulmonary bypass or other technologies are used after a “hands off” period, to restore circulation to the vital organs or even to restart the heart. The aim is to preserve circulation to the organs, thereby increasing the quality and number of organs for transplant.

However, ACP says NRP-cDCD is more accurately described as organ retrieval after cardiopulmonary arrest and the induction of brain death. It raises significant ethical concerns and questions regarding the dead donor rule, fundamental ethical obligations of respect, beneficence, and justice, and the imperative to never use one individual merely as a means to serve the ends of another, no matter how noble or good those ends may be. ACP finds that questions and concerns about NRP-cDCD have not been adequately considered.

“This new method of organ retrieval raises profound ethical questions regarding determination of death, respect for patients, and the ethical obligation to do what is best for patients,” said George M. Abraham, MD, MPH, FACP, President, ACP. “Valid ethical arguments—not just assertions—must serve as the foundation for organ transplantation, consistent with U.S. legal and ethical standards for determination of death. Otherwise public trust and confidence in health care and in organ donation— things we need more of— are jeopardized.”

ACP recommends pausing the use of NRP-cDCD and calls for further professional and public discussion of this practice.