[Heart donation after circulatory death: ethical and emotional aspect of central normothermic regional perfusion]

Heart transplantation after circulatory death is possible in different countries with the use of ex situ normothermic perfusion of the donor heart. Central normothermic regional perfusion, where the circulation in the donor is restarted using an extracorporeal life support system after circulatory death, may give a better 1-years survival and a reduction in costs compared to ex situ normothermic perfusion of the donor heart. However, restarting circulation in a donor that was just declared death by circulatory criteria may be controversial. The advantages described are, in our view, reason to consider central normothermic regional perfusion, in which case a debate on ethical and emotional aspects is of great importance. In this article, we describe two point of views and hope in this way to start the debate on central normothermic regional perfusion in the Netherlands.