Use of normothermic regional perfusion (NRP) to enable organ reconditioning and assessment in donation after circulatory determination of death is controversial. We conducted a scoping review of peer-reviewed articles, news media, legal literature, and professional society position statements addressing ethical and/or legal issues in use of NRP in controlled donation after circulatory determination of death from January 1, 2005, to January 5, 2024. Thematic analysis, assessing the 4 principles of bioethics (autonomy, beneficence, nonmaleficence, and justice) and subthemes identified within each, was conducted for the 112 publications meeting inclusion criteria. More than 30 publications addressed the topic in each of 2022 and 2023, vs ≤6 per year previously. Nonmaleficence was the most frequently addressed bioethical principle (111/112 publications), and the most varied, with 14 subthemes. Attitudes toward NRP differed by type of NRP: of 72 publications discussing thoracoabdominal NRP, 22 (30.6%) were “In Favor,” 39 (54.2%) were “Neutral,” and 11 (15.3%) were “Against”; of 44 discussing abdominal NRP, 23 (52.3%) were “In Favor,” 20 (45.5%) were “Neutral,” and 1 (2.3%) was “Against.” Attitudes differed by authors’ country, degree, and affiliation, and by the clinical focus of the publishing journal. Overall, our review shows that the ethical and legal issues raised by NRP remain unresolved, and the debate centered on nonmaleficence.

中文翻译：

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对 2005 年至 2023 年循环确定死亡后在受控捐献中使用常温区域灌注的法律和伦理挑战的范围审查


在循环确定死亡后，使用常温区域灌注 （NRP） 进行器官修复和捐献评估是有争议的。我们对同行评审文章、新闻媒体、法律文献和专业协会立场声明进行了范围审查，这些文章解决了 2005 年 1 月 1 日至 2024 年 1 月 5 日循环确定死亡后在受控捐献中使用 NRP 的伦理和/或法律问题。对符合纳入标准的 112 篇出版物进行了主题分析，评估了生物伦理学的 4 项原则（自主、仁慈、非恶意和正义）以及每项原则中确定的子主题。2022 年和 2023 年每年有 30 多篇出版物讨论该主题，而之前每年有 ≤6 篇。非恶意是最常被提及的生物伦理原则（111/112 出版物），也是最多样化的，有 14 个子主题。对 NRP 的态度因 NRP 类型而异：在讨论胸腹 NRP 的 72 篇出版物中，22 篇 （30.6%） 为“赞成”，39 篇 （54.2%） 为“中立”，11 篇 （15.3%） 为“反对”;在 44 个讨论腹部 NRP 的人中，23 人 （52.3%） “赞成”，20 人 （45.5%） “中立”，1 人 （2.3%） “反对”。态度因作者的国家、学位和隶属关系以及出版期刊的临床重点而异。总体而言，我们的审查表明，NRP 提出的道德和法律问题仍未解决，辩论集中在非恶意上。