The controversial technique of reviving organs for transplants – 07/10/2023 – Science

He had three months to live. At just 41 years old, Anthony Donatelli was in a hospital bed waiting for a donor.

Each day, each hour, each passing minute was a countdown to what until then had seemed inevitable. Despite everything, Donatelli was hopeful that he would stay alive.

“Thinking about my children, I never gave up”, tells the American to BBC News Mundo, the BBC’s Spanish-language news service.

He had amyloidosis, a rare disease that occurs when certain abnormal proteins build up in the body, forming deposits. His only alternative was the appearance of a donor who would give him three compatible organs.

Until that day came. In February last year, Donatelli became the first person in the world to receive a triple transplant of heart, liver and kidney, using a technique called PRN (regional normothermic perfusion).

Today he is enjoying every moment with his family and although some days are more difficult than others, he is back to swimming and surfing the Atlantic waves.

“I just got back from the race,” says Donatelli, now retired from the Army and on the mend.

“I have an amazing life,” says this father of two boys, aged 4 and 7.

The person responsible for one of the organ transplants that Donatelli received, the heart, was Victor Pretorius, surgical director of Heart Transplantation at the University of California San Diego health system, in the USA.

“We used an innovative technology that allowed us to obtain organs that historically would have been discarded”, says the doctor.

The debate in the US medical community about life and death

Not everyone agrees with this view.

Some physicians are opposed to the PRN technique, especially for heart transplants, because it circulates the dead person’s oxygenated blood inside the body until the heart starts beating again.

These are donors with catastrophic irreversible brain damage who are kept alive artificially with the help of life support devices.

With the family’s consent, physicians practicing PRN turn off the devices; cardiorespiratory arrest occurs and, after waiting at least five minutes, the patient is declared dead.

Then, with the help of a machine, doctors pump the donor’s blood to reactivate the functioning of the heart and lungs. This allows them to assess whether the organ is fit for a transplant, as well as preventing it from deteriorating.

As this is a race against time, the procedure is done as quickly as possible.

Although PRN has been practiced for several years in countries such as Australia, United Kingdom, Spain, France, Portugal, Italy and Sweden, the debate “for ethical reasons” has gained momentum in the United States. So far, according to publicly available information, the technique has not been used in Latin America.

According to critics, reactivating the donor heart activity is like bringing a dead person back to life.

The concern reached a point where the American College of Physicians issued a public statement in April 2021 requesting a pause in the adoption of PRN as it raises “deep ethical questions regarding the determination of death”.

“PRN resuscitates the patient,” the document states.

The central argument is that the reactivation of blood circulation reverses what had been declared irreversible: the patient’s death.

Some Organ Procurement Organizations (OPOs) agree with this position.

The president and executive director of one of these organizations, Alexandra Glazier, tells BBC News Mundo that for them, the essential thing in this discussion is that the dead donor’s rights are respected.

She says her organization, New England Donor Services, is currently in the process of adopting PRN for abdominal organ transplants only.

The idea is “to prevent wider circulation in the donor’s body and thus prevent the heart from reactivating,” explains Glazier.

‘Doesn’t bring a dead person back to life’

Brendan Parent, Nader Moazami, Arthur Caplan and Robert Montgomery, medical specialists at the University of New York, USA, published in 2022 in the scientific journal American Journal of Transplantation a response to the statements of the American College of Physicians who criticized the procedure.

In the text, they claim that pumping blood to the thoracic organs does not change the fact that the heart will not reactivate on its own.

The PRN technique, they argue, does not change the circumstances that led the family and the medical team to conclude that there is no longer any chance of a meaningful life for the patient with catastrophic brain damage declared dead from cardiac arrest.

PRN “does not resuscitate the patient”, say professionals. The procedure pumps blood into the dead donor’s organs, but does not revive him.

It is an “honest, transparent and respectful” organ recovery because the death was declared “in an ethical manner”.

In conversation with BBC News Mundo, physician Nader Moazami explains that, when a person dies from cardiorespiratory arrest (also called circulatory death), the best way to assess whether the heart is fit for a transplant is to restore circulation while the organ it is still in the donor’s body.

Moazami, surgical director of Heart Transplantation and Mechanical Circulatory Support at NYU Langone Health, explains that since they started using the technique in 2020, hearts that were previously non-viable have been salvaged.

Restoring circulation, he says, is simply another method for restoring organs.

“It has nothing to do with bringing a patient back to life, it’s not resuscitating the donor, because resuscitation, by definition, means you’re going to restore longevity or quality of life.”

The decision on the patient’s death, he adds, comes when the family decides to turn off life support devices.

“You don’t bring a dead person back to life. People like to play with words, but that’s not the case.”

“The PRN is completely ethical.”

While the debate continues in the United States, the technique continues to advance in developed countries.

There are currently pilot projects in countries such as Switzerland, the Netherlands, Norway and Canada.

This text was originally published here.