Ethical controversies in organ procurement: A national survey on public perceptions of thoracoabdominal normothermic regional perfusion

Abstract

Thoracoabdominal normothermic regional perfusion (TA-NRP) would likely expand the quantity and quality of organs procured after controlled circulatory death donation in the United States, yet its ethical permissibility remains contested. We surveyed a representative sample of US adults (n = 975) with the goal of assessing their perspectives on the ethical permissibility of TA-NRP. After reading a neutral description of TA-NRP, participants judged its permissibility, reviewed 5 critic and 5 supporter arguments (in random order), and chose which argument they found most convincing. Multivariable logistic regression examined predictors of agreeing with critics. Before exposure to the arguments, 51.5% stated that TA-NRP should be used, 34.2% were uncertain, and 14.4% stated it should not be used. After reviewing arguments, 60.6% agreed with supporters and 39.4% with critics. Two-thirds of those initially uncertain sided with critics. Agreement with critics was associated with religious service attendance, less trust in doctors, nonregistration as an organ donor, and being Black/African American. Participants who agreed with supporters cited TA-NRP’s capacity to benefit more patients, whereas those who agreed with critics doubt that donors are irreversibly dead. Although the majority supports TA-NRP, a substantial minority—concentrated among religious, distrustful, and historically underserved participants—remains unconvinced.