# A new way to donate organs—is it ethical? | Harrison Lee | TEDxUniversityofMississippi

Source: https://www.youtube.com/watch?v=wcQkvw9TiF8
Recap page: https://rapidrecap.app/video/wcQkvw9TiF8
Generated: 2025-12-14T13:32:04.011+00:00

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## Quick Overview

The ethical controversy surrounding Normothermic Regional Perfusion (NRP) stems from the objection that the procedure, which involves blocking blood flow to the brain while perfusing other organs, effectively kills the donor, an action that opponents argue violates the permanence criterion of death which requires irreversible loss of circulation; however, the speaker argues that this objection is misplaced because both NRP and standard machine perfusion (NMP) involve stopping circulation to the brain, and in both protocols, the donor is declared dead using the same circulatory criteria after a mandated waiting period, meaning neither procedure causes death, but rather utilizes organs from individuals already declared dead.

**Key Points:**
- There are currently about 105,000 people on the national transplant waitlist, with 17 people dying daily waiting for organs.
- The key ethical objection to Normothermic Regional Perfusion (NRP) is that it "kills the donor" by occluding arteries to the brain during organ retrieval.
- Both NRP and Normothermic Machine Perfusion (NMP) involve declaring death based on the same circulatory criteria (no circulation for five minutes after attempting resuscitation).
- The permanence criterion for death states a donor is dead if they have lost circulation and will never regain it, which is met before organ retrieval in both procedures.
- NRP allows procurement teams to assess organ function (heart, liver) while still inside the donor body, leading to more viable organs for transplantation compared to NMP.
- The speaker argues that the objection is flawed because the donor is already declared dead based on established circulatory criteria before either NRP or NMP procedures begin.
- NRP enables organs to be perfused with oxygenated blood immediately after declaration of death, preserving viability for transplantation, unlike standard NMP.

![Screenshot at 01:22: The slide explicitly states the central objection being addressed: "The Objection: Regional Perfusion \(NRP\) kills the donor," setting the stage for the speaker to refute this claim regarding organ procurement ethics.](https://ss.rapidrecap.app/screens/wcQkvw9TiF8/00-01-22.png)

**Context:** The speaker, Harrison Lee, addresses the ethical controversy surrounding Normothermic Regional Perfusion (NRP), a procedure used in organ donation for individuals declared dead by circulatory criteria (DCD donors). The primary ethical concern raised by opponents is that the act of blocking blood flow to the brain during organ retrieval constitutes actively killing the donor, thereby violating the established permanence criterion for declaring death. The presentation contrasts NRP with the existing standard, Normothermic Machine Perfusion (NMP), to argue why NRP is ethically sound and medically advantageous.

## Detailed Analysis

Harrison Lee opens by highlighting the severe organ shortage crisis in the United States, noting that 105,000 people wait for transplants, and 17 die daily waiting. He directly confronts the primary ethical objection to Normothermic Regional Perfusion (NRP): that it kills the donor by blocking arterial blood supply to the brain during organ recovery. He points out that the current standard for death declaration—the permanence criterion—requires irreversible cessation of circulation for five minutes after resuscitation efforts fail. Lee explains that both NRP and Normothermic Machine Perfusion (NMP) adhere to this same criterion for declaring death prior to proceeding with organ retrieval. The difference is that NRP allows surgeons to occlude the arteries leading to the brain while immediately initiating perfusion in the chest and abdomen, enabling them to assess the viability of the heart and liver organs while they are still inside the body. This assessment allows procurement teams to honor the donor's wishes to donate healthy organs that would otherwise be discarded under less rigorous assessment methods like NMP. Lee concludes that the objection that NRP kills the donor is based on a misunderstanding; since the donor is already declared dead by established circulatory criteria, the subsequent steps are about organ preservation and transplantation, not causing death.

### Organ Shortage Crisis Statistics

- 105,000 people on the national transplant waitlist
- 17 people die daily waiting for organs

### The Ethical Objection

- Regional Perfusion (NRP) kills the donor because it involves blocking arteries leading to the brain.

### The Permanence Criterion for Death

- A donor is dead if they have lost circulation and will never regain it; this is met before organ recovery in both NRP and NMP.

### NRP Procedure Steps

- 1. Do-Not-Resuscitate
- 2. Wait for five minutes
- 3. Declare death
- 4. Occlude arteries
- 5. Reinitiate circulation (external pump)
- 6. Organs retrieved

### Advantages of Regional Perfusion

- Allows assessment of organ function before retrieval
- Enables retrieval of more organs (e.g., heart and liver from the same donor)
- Organs are perfused with oxygenated blood immediately after death is declared.

### Refuting the Objection

- The claim that NRP causes death is false because both NRP and NMP use the same criteria (5-minute circulatory arrest) to declare death before organs are removed; the procedure does not violate the donor's DNR wishes.

![Screenshot at 00:01: The transition screen shows the distinctive red and grey interlocking pattern associated with the TEDx University of Mississippi event, themed "Purpose & Potential".](https://ss.rapidrecap.app/screens/wcQkvw9TiF8/00-00-01.png)
![Screenshot at 00:11: Speaker Harrison Lee walks onto the stage as his name appears at the bottom of the screen, signaling the start of his presentation.](https://ss.rapidrecap.app/screens/wcQkvw9TiF8/00-00-11.png)
![Screenshot at 01:22: A slide appears stating the core ethical challenge: "The Objection: Regional Perfusion \(NRP\) kills the donor," which the speaker intends to address.](https://ss.rapidrecap.app/screens/wcQkvw9TiF8/00-01-22.png)
![Screenshot at 02:05: A diagram illustrates the Normothermic Regional Perfusion \(NRP\) process, showing an external pump oxygenator connected to the donor's major vessels for localized perfusion of the chest and abdominal organs.](https://ss.rapidrecap.app/screens/wcQkvw9TiF8/00-02-05.png)
![Screenshot at 06:57: A slide defining the ethical standard under scrutiny: "Permanence Criterion: A donor is dead if they have lost circulation and they will never regain it," with a microscopic image background.](https://ss.rapidrecap.app/screens/wcQkvw9TiF8/00-06-57.png)