2025/10/18 by Jaden Blazier, Emma K. Massey, Esther W. de Bekker‐Grob +4 · 1 voice
Medicine · #Organ Donation and Transplantation #Organ Transplantation Techniques and Outcomes #Organ and Tissue Transplantation Research
paper · doi:10.1016/j.ajt.2025.10.011
openalex publication_date 2025/10/18 · openalex created_date 2025/10/19 · openalex updated_date 2026/07/28
Perfusion technology is increasingly used to assess and/or enhance organ viability by circulating blood or blood substitutes through organs, improving transplant outcomes. Both ex situ and in situ techniques present distinct ethical issues that must be considered during implementation. Perspectives of stakeholders can illuminate key concerns. This scoping review maps the literature on ethical and psychosocial issues related to perfusion technology, comparing techniques. We searched Embase, Medline, CINAHL, PsycINFO, and Google Scholar for articles discussing these issues, without date limits. We included peer-reviewed articles in English, using thematic analysis to extract and synthesize themes. 141 articles were included, and 9 themes were identified. 89% of articles discussed in situ normothermic regional perfusion (67% in-depth), with a focus on in situ thoracoabdominal normothermic regional perfusion and determination of death. Ex situ machine perfusion appeared in 61% of articles (16% in-depth) with the theme of justice/allocation highlighted due to machine perfusion's potential to exacerbate or ameliorate inequities in transplant access. To clarify debated issues and inform policy, both techniques require further qualitative research and ethical analysis, particularly regarding allocation, dignity, informed consent, and the moral status of ex situ organs.