PRN technique: innovative and controversial

A resident of San Diego, California, received bad news regarding his health. His doctor informed him that he had only three months to live. He was to undergo a triple heart, liver and kidney transplant. Thanks to the innovative PRN (normothermic regional perfusion) technique, the multiple transplant was successful and the man was able to continue his life.

PRN Technique

PRN is controversial

This topic opened a debate within the medical community and also in the U.S. society. The technique consists of causing oxygenated blood to circulate inside the body of a deceased person until the organ destined for transplantation becomes functional again. For example, if the organ in question is a heart, to make it beat again.

Donors are patients with catastrophic and irreversible brain damage, kept alive artificially by life support. With the authorization of their relatives, physicians disconnect life support and cardiorespiratory arrest occurs. From that moment, they allow five minutes to pass and thereafter the person is considered to have died.

After this action and with the help of technology, professionals pump the donor’s blood to reactivate the heartbeat and lung function. PRN allows professionals to determine if the organs are suitable for transplantation.

It is a method already used in developed countries such as Australia, Spain, United Kingdom, Sweden, Portugal, Italy, France and some others. In the United States, however, there has been much debate on ethical grounds.

Ethics-based grounds generate a discussion on life and death.

For many, the technique of restarting cardiac activity in a deceased person is like trying to bring him or her back to life. The debate reached the American College of Physicians, which called for a pause in the application of PRN. They consider that they are questioning the determination of death. For those who reject the application of this method, the resumption of blood circulation is a regression of the patient to life. As such, it is an encroachment on the rights of the dead patient.

For this reason, they analyze applying this technique only on abdominal organs. This would avoid the controversial circulation of blood throughout the body of the deceased donor in order for the heart to start beating again.

Several physicians from New York University, published in the American Journal of Transplantation a response to the American College of Physicians. According to them, pumping blood to the organs in the thorax does not imply that the heart restarts. In other words, the PRN technique cannot resuscitate the person, it only pumps blood into the body of the deceased to allow their organs to be used in transplants.

Numerous physicians and specialists believe that those who oppose PRN are playing with words. It is not about bringing a person back from the dead, but about saving other lives with their organs.

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