2023-07-15 16:22:17
an hour ago
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PRN is a transplantation technique that has successfully increased the number of usable organs.
He had three months left to live.
At the age of 41, Anthony Donatelli lay in a hospital bed waiting for a donor.
As in an agonizing nightmare, each day, each hour, each passing minute was a countdown towards what seemed inevitable.
Despite everything, Anthony Donatelli kept the hope of staying alive.
“Thinking about my children, I never gave up,” the American told BBC Mundo from San Diego, California.
He had amyloidosis, a rare disease that occurs when certain abnormal proteins build up in the body and form deposits.
His only alternative was for a donor to come forward with three matching organs.
Until that day comes. In February last year, Donatelli became the first person in the world to receive a triple heart, liver and kidney transplant, using a technique called PRN (normothermic regional perfusion).
Today he enjoys every moment with his family and, although some days are more difficult than others, he is back to swimming and surfing the waves of the Atlantic.
“I just got home from running,” says Donatelli, now retired from the military and on the road to recovery.
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This technique is used in the United States and other countries such as Spain, France, Portugal, Italy, Sweden, United Kingdom and Australia.
“I have an extraordinary life,” says the father of two children, aged 4 and 7.
Victor Pretorius, surgical director of the heart transplant service at the University of California San Diego Health System, was in charge of one of the organ transplants Donatelli received, namely the heart transplant.
“We used innovative technology that allowed us to obtain organs that historically would have been discarded,” he explains.
The American medical community’s debate over life and death
Not everyone agrees with this point of view.
Some doctors object to the PRN technique, especially for heart transplants, because it circulates oxygenated blood from the deceased through their body until the organ starts beating again.
These are donors with irreversible and catastrophic brain damage, who are kept artificially alive using an artificial respirator.
With the agreement of the family, the doctors of the PRN disconnect the artificial respirator; cardio-respiratory arrest occurs and, after waiting at least five minutes, the patient is pronounced dead.
Then, using a machine, doctors pump blood from the donor to reactivate the functioning of the heart and lungs. This allows them to assess the organ’s suitability for transplantation and prevent it from deteriorating.
As it is a race against time, the procedure is carried out as quickly as possible.
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Not all doctors agree with pumping blood into the donor’s body and giving it back its heartbeat.
Although PRN has been practiced for several years in countries such as Australia, the United Kingdom, Spain, France, Portugal, Italy and Sweden, the debate, “for ethical reasons”, has taken scale in the United States.
According to its detractors, restarting the heart activity of a deceased person is tantamount to bringing the dead back to life.
Such is the concern that the American College of Physicians issued a public statement in April 2021 calling for a pause in the implementation of PRN as it raises “profound ethical questions regarding the determination of death”.
“NPR resuscitates the patient,” the document states.
The central argument is that the restoration of blood circulation reverses what had been declared irreversible: the death of the patient.
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According to the American College of Physicians, the PRN technique “resuscitates” the deceased donor by restoring their heartbeats.
Some organ procurement organizations (OPOs) agree with this position.
The president and chief executive of one of these organizations, Alexandra Glazier, told BBC Mundo that for her the main thing in this discussion is that the rights of the deceased donor are respected.
She explains that her organization, New England Donor Services, is currently implementing the PRN only for abdominal organ transplants.
The idea is “to avoid new circulation in the body of the donor and therefore to avoid restarting the heart”, explains Ms. Glazier.
“You don’t bring a dead person back to life”
Brendan Parent, Nader Moazami, Arthur Caplan and Robert Montgomery, medical specialists from New York University (NYU), published in 2022 in the American Journal of Transplantation a response to claims by the American College of Physicians criticizing the procedure .
They claim that pumping blood into the chest organs does not change the fact that the heart does not restart on its own.
The PRN technique, they claim, does not change the circumstances that led the family and the medical team to conclude that there was no longer any chance of giving meaning to the life of the patient suffering from catastrophic brain damage and declared dead following a cardiopulmonary arrest.
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Doctors who perform PRN say it is an “honest, transparent and respectful” technique.
PRN “does not resuscitate the patient”, say the professionals. The procedure involves pumping blood into the deceased donor’s organs, but does not resuscitate them.
It is “honest, transparent and respectful” organ harvesting, as death is declared “ethically”.
Speaking to BBC Mundo, doctor Nader Moazami explains that when someone has died of cardio-respiratory arrest (also known as circulatory death), the best way to assess whether their heart is suitable for transplant is to restore circulation while the organ is still in the donor’s body.
Dr. Moazami, Surgical Director of the Heart Transplantation and Mechanical Circulatory Support Department at NYU Langone Health, explains that since they began using this technique in 2020, hearts that were previously non-viable have been recovered. .
According to him, restoring circulation is just another method of organ recovery.
“It has nothing to do with bringing a patient back to life, it’s not about resuscitating the donor, because resuscitation, by definition, means that we are going to restore the longevity or the quality of life.
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“You don’t bring a dead person back to life,” explains doctor Nader Moazami.
The decision about the patient’s death, he adds, comes when the family decides to end life support.
“You don’t bring a dead person back to life. People like to play with words, but that’s not how things are,” he notes. “PRN is entirely ethical.
While the debate continues in the United States, the technique continues to advance in developed countries.
Pilot projects are currently underway in countries such as Switzerland, the Netherlands, Norway and Canada.
So far, according to publicly available information, it has not been used in Latin America.
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