(LifeSiteNews) — In the never-ending quest for viable organs, doctors have found a macabre new way to skirt both the brain death and circulatory death criteria: normothermic regional perfusion, or NRP for short.
Transplant centers around the country are removing people who have signed a do not resuscitate (DNR) order from life support, waiting for their hearts to stop, and then immediately clamping off the blood flow to their brains to make them brain dead on purpose. Then their organs are resuscitated, but the person doesn’t wake up because the circulation to their brain has been clamped off. In this way, the dead donor rule and the legal requirements of the Uniform Determination of Death Act (UDDA) are met by sleight of hand. First, the patient is declared dead according to the UDDA’s circulatory death criterion. Then, because doctors are planning to restart the patient’s heart, they make the patient brain dead on purpose so that now they are legally covered by the UDDA’s brain death clause. The protocol for the NRP procedure from the University of Nebraska notes: “The initial step for ligation of the blood vessels to the head is necessary to ensure that blood flow to the brain does not occur. Once blood flow to the heart is established, the heart will start beating.” How dead are you if doctors can restart your heart in your own chest?
Many doctors, lawyers, and ethicists take strong exception to NRP. Dr. Matthew DeCamp, a bioethicist at the University of Colorado, along with Dr. Joseph Fins and attorney Lois Sulmasy believe NRP violates the ethical principles of organ procurement, saying, “Restarting circulation reverses what was just declared to be the irreversible cessation of circulatory and respiratory function. It is no defense to suggest the patient was already dead when the action negates the conditions upon which that determination was made.” Other nations, such as Australia, have banned NRP altogether.
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The American College of Physicians (ACP) recommended in 2021 that the practice of NRP be paused, as “the burden of proof regarding the ethical and legal propriety of this practice has not been met.” They gave four reasons for their concern:
- NRP appears to violate the dead donor rule, which states that donors cannot be made dead in order to obtain their organs and that organ retrieval cannot cause death.
- NRP has ethical implications from the standpoint of justice. NRP seems likely to disproportionately target drug overdose victims as opposed to other types of donors, and it would be wrong to target a socially stigmatized population with this technique.
- If patients or family members of both the donor and the recipient are not made aware of the full details of what this protocol involves, this lack of transparency can damage trust in health care and clinical research. More importantly, informed consent alone cannot confer ethical legitimacy on NRP: standards of medical ethics do not permit consent to supersede all other ethical considerations.
- Alternatives to NRP exist which allow organ reperfusion to be accomplished outside of the body. “There is a large and significant difference between perfusing an organ versus perfusing an individual.”
Unfortunately, the ACP’s call for a pause has fallen on deaf ears, and the practice of NRP organ retrieval is increasing and expanding across the US. Thus, in 2024 the American Journal of Bioethics devoted an edition of their publication to discussing the NRP technique. Lauris Kaldjian, MD, PhD, director of the program in bioethics and humanities at the University of Iowa Carver College of Medicine wrote, “NRP represents a technologically elaborate attempt to refashion definitions of death to maximize the number and quality of transplanted organs. It both depends on and violates the circulatory definition of death and arguably employs iatrogenic [doctor-induced] brain death.” In the same edition, Dr. David Magnus describes his discomfort with NRP this way:
A quick rule of thumb in bioethics should be that relying on not telling people what you are doing or attempting to obfuscate with misleading language is a pretty good indication that you are on the wrong track. While some NRP advocates want transparency and complete disclosure, too many leaders and professional organizations have pushed for obfuscation. This is at a minimum a red flag for NRP.
How many families would give their loved ones over to transplant teams if they knew the grisly reality taking place behind operating room doors? While professionals debate the ethics of NRP, people continue to sign their donor cards in ignorance of these facts. Dr. Michael Nair-Collins has written extensively about the fact that the public is never given sufficient information about what actually takes place during organ procurement surgery, and therefore donors and families do not provide valid consent for the procedure:
The determination of death is a fundamental question for all human societies, and it will affect all of us. This issue draws on long cultural traditions, and on deep philosophical, religious, and political worldviews and value systems. Everyone has the right and ability to participate in informed dialogue about how we ought to define death. Thus, if identifying when death occurs is a choice, then the choice is properly one for all of us, not an elite few.
The fact that NRP organ procurement is already in progress without any type of informed consent is a serious breach of public trust. Because the concerns of doctors, lawyers, bioethicists and medical societies are currently being ignored, it falls on the public to hold the transplant industry accountable. Everyone should refuse to participate in this system until full disclosure is made about the practice of NRP and justice is offered to those who have unknowingly been made unwilling participants.
RELATED: Don’t be fooled: Organ harvesting after ‘circulatory death’ kills living donors
Heidi Klessig MD is a retired anesthesiologist and pain management specialist who writes and speaks on the ethics of organ harvesting and transplantation. She is the author of “The Brain Death Fallacy” and her work may be found at respectforhumanlife.com.
