Normothermic Regional Perfusion (NRP) is increasingly being adopted as an intervention designed to improve organ utilization from donors after circulatory death because of the efficiency with which...

Old habits die hard; so, it seems, do old arguments. Proponents of thoracoabdominal normothermic regional perfusion (TA-NRP, but more commonly referred to as NRP) continue to proffer arguments and...

In their article, Nielsen Busch and Mjaaland defend the moral permissibility of cDCD, suggesting that much of the controversy around this donation practice has been the result of a misinterpretatio...

The articles by Bernat, Busch, Dudzinski et al., and Derse illustrate the difficulties with reconciling normothermic regional perfusion (NRP) with the dead donor rule (DDR) (Bernat forthcoming; Busch forthcoming; Dudzinski et al. forthcoming; Derse forthcoming). I appreciate their arguments because they help illuminate the issues that generate a dilemma: either reject NRP or the DDR. I am convinced that the dilemma is unavoidable because the procurement team is involved with determining and securing the death of the donor when circulation restarts. (...) Evidence for this is found in the reasons and recommendations given for blocking blood flow to the brain, both of which betray a lack of certainty over the donor’s vital status. The surgical activity in NRP therefore conflicts with the values the DDR protects: respect for the donor’s life and avoidance of conflict of interest. (shrink)

The introduction of normothermic regional perfusion (NRP) in controlled donation after circulatory determination of death (cDCDD) protocols is by some regarded as controversial and ethically troublesome. One of the main concerns that opponents have about introducing NRP in cDCDD protocols is that reestablishing circulation will negate the determination of death by circulatory criteria, potentially resuscitating the donor. In this article, I argue that this is not the case. If we take a closer look at the concept of death underlying the (...) circulatory criterion for determination of death, we find that the purpose of the criterion is to show whether the organism as a whole has died. I argue that this purpose is fulfilled by the circulatory criterion in cDCDD protocols, and that applying NRP does not negate the determination of death or resuscitate the donor. (shrink)

An adult university hospital ethics committee evaluated a proposed TA-NRP protocol in the fall of 2018. The protocol raised ethical concerns about violation of the Uniform Determination of Death Act and the prohibition known as the Dead Donor Rule, with potential resultant legal consequences. An additional concern was the potential for increased mistrust by the community of organ donation and transplantation. The ethics committee evaluated the responses to these concerns as unable to surmount the ethical and legal boundaries and the (...) ethics committee declined to endorse the procedure. These concerns endure. (shrink)

ABSTRACT This study explores the influence of the French Symbolist poet, novelist, and literary critic Remy de Gourmont on Chaïm Perelman and Lucie Olbrechts-Tyteca's conception of dissociation. It proposes translatio—the medieval trope describing a transfer of ideas—as a lens through which to read the significance of Gourmont's thought on the New Rhetoric Project. Thus forgoing more traditional comparative approaches such as intertextuality, this study argues that translatio serves here as a particularly valuable conceptual tool: it unveils the evolution of Perelman's (...) thought over time, and Olbrechts-Tyteca's significant contribution to it; it also provides a clearer understanding of the relationship between association and dissociation in the NRP than what is generally understood by scholars of the Traité. More importantly, translatio unveils the features that make their conception of dissociation one of the truly innovative aspects of the NRP. (shrink)

Organ donation after the circulatory determination of death requires the permanent cessation of circulation while organ donation after the brain determination of death requires the irreversible cessation of brain functions. The unified brain-based determination of death connects the brain and circulatory death criteria for circulatory death determination in organ donation as follows: permanent cessation of systemic circulation causes permanent cessation of brain circulation which causes permanent cessation of brain perfusion which causes permanent cessation of brain function. The relevant circulation that (...) must cease in circulatory death determination is that to the brain. Eliminating brain circulation from the donor ECMO organ perfusion circuit in thoracoabdominal NRP protocols satisfies the unified brain-based determination of death but only if the complete cessation of brain circulation can be proved. Despite its medical and physiologic rationale, the unified brain-based determination of death remains inconsistent with the Uniform Determination of Death Act. (shrink)

Donation after circulatory determination of death (DCDD) is an accepted practice in the United States, but heart procurement under these circumstances has been debated. Although the practice is experiencing a resurgence due to the recently completed trials using ex vivo perfusion systems, interest in thoracoabdominal normothermic regional perfusion (TA-NRP), wherein the organs are reanimated in situ prior to procurement, has raised many ethical questions. We outline practical, ethical, and equity considerations to ensure transplant programs make well-informed decisions about TA-NRP. We (...) present a multidisciplinary analysis of the relevant ethical issues arising from DCDD-NRP heart procurement, including application of the Dead Donor Rule and the Uniform Definition of Death Act, and provide recommendations to facilitate ethical analysis and input from all interested parties. We also recommend informed consent, as distinct from typical “authorization,” for cadaveric organ donation using TA-NRP. (shrink)

Bernat argues for a unified brain-based determination of death (UBDD), noting that it “conceptually justifies” death determination both in Donation after Circulatory Determination of Death (DCDD) a...

This issue covers a topic widely being discussed at Ethics Committee meetings around the country, namely the line between life and death in organ procurement. While the debate over whether and when...

Bernat (2024) and Busch (2024) both argue that the clamping of cerebral vasculature in NRP-cDCD ensures sufficient diagnostic certainty of death that the procedure does not violate the Dead Donor R...

In his article, “The Unified Brain-Based Determination of Death Conceptually Justifies Death Determination in DCDD and NRP Protocols,” James Bernat argues that Thoracoabdominal Normothermic Regiona...

Other than the ligation of the aortic arch vessels, extracorporeal cardiopulmonary resuscitation (ECPR) and thoraco-abdominal normothermic regional ­perfusion (TA-NRP) in donation after circulatory...

In his article, a unified brain-based determination of death is described by James Bernat (2024) as a permanent cessation of systemic circulation causing a permanent cessation of brain circulation...

Legal interpretations of the Uniform Determination of Death Act (UDDA) can and have evolved over time. Interpretation of the statutory term “irreversible” (circulation cannot ever resume) to mean “...

Normothermic Regional Perfusion, or NRP, is a method of donated organ reperfusion using cardiopulmonary bypass or a modified extracorporeal membrane oxygenation (ECMO) circuit after circulatory death while leaving organs in the dead donor’s corpse. Despite its potential, several key ethical issues remain unaddressed by this technology.

NRP is a family of views differing by how they understand “reduction” and “physicalism.” Following Kim I understand the non-reduction as holding that some events and properties are distinct from any physical events and properties. A necessary condition for physicalism is that mental properties, events, and laws supervene on physical ones. Kim allows various understandings of “supervenience” but I think that physicalism requires at least the claim that any minimal physical duplicate of the actual world is a duplicate simpliciter. Some (...) complications aside this means that true mental propositions, e.g. Jaegwon is thinking about sailing, are metaphysically entailed by true physical propositions. Kim says that supervenience is too weak to capture the root idea of physicalism that mental property instantiations depend on physical property instantiations so he adds that the mental depends on the physical. One way in which this dependance might be spelled out is that mental properties are higher order functional properties whose instantiations are realized by instantiations of physical properties. An event is an instantiation of a property by an individual and a time. A mental event is the instantiation of a mental property. Not every predicate expresses a genuine property. Kim further suggests that properties are individuated, at least partly, by nomological and causal relations. For physicalism to have content something must be said about the difficult issue of characterizing the physical. Kim’s view seems to be that the micro-physical properties of ideal physics are physical. He also counts as physical properties that are conjunctions and aggregates of micro-physical properties and higher level properties defined over lower-level physical properties.. Since these latter two classes of properties supervene on the micro-properties and laws there is no need to include them in the supervenience base. (shrink)

NRP is a family of views differing by how they understand “reduction” and “physicalism.” Following Kim I understand the non-reduction as holding that some events and properties are distinct from any physical events and properties. A necessary condition for physicalism is that mental properties, events, and laws supervene on physical ones. Kim allows various understandings of “supervenience” but I think that physicalism requires at least the claim that any minimal physical duplicate of the actual world is a duplicate simpliciter. Some (...) complications aside this means that true mental propositions, e.g. Jaegwon is thinking about sailing, are metaphysically entailed by true physical propositions. Kim says that supervenience is too weak to capture the root idea of physicalism that mental property instantiations depend on physical property instantiations so he adds that the mental depends on the physical. One way in which this dependance might be spelled out is that mental properties are higher order functional properties whose instantiations are realized by instantiations of physical properties. An event is an instantiation of a property by an individual and a time. A mental event is the instantiation of a mental property. Not every predicate expresses a genuine property. Kim further suggests that properties are individuated, at least partly, by nomological and causal relations. For physicalism to have content something must be said about the difficult issue of characterizing the physical. Kim’s view seems to be that the micro-physical properties of ideal physics are physical. He also counts as physical properties that are conjunctions and aggregates of micro-physical properties and higher level properties defined over lower-level physical properties.. Since these latter two classes of properties supervene on the micro-properties and laws there is no need to include them in the supervenience base. (shrink)

The Next Release Problem (NRP) is a combinatorial optimization problem that aims to find a subset of software requirements to be delivered in the next software release, which maximize the satisfaction of a list of clients and minimize the effort required by developers to implement them. Previous studies have applied various metaheuristics, mostly genetic algorithms. Estimation of Distribution Algorithms (EDA), based on probabilistic modelling, have been proved to obtain good results in problems where genetic algorithms struggle. In this paper we (...) propose to adapt three EDAs to tackle the multi-objective NRP in a fast and effective way. Results show that EDAs can be applicable to solve the NRP with rather good quality of solutions. Furthermore, we prove that their execution time can be significantly reduced using a per-iteration solution subset selection method while maintaining the overall quality of the solutions obtained, and they perform the best when limiting the search time as in an interactive tool that requires fast responsiveness. The experimental framework, code and datasets have been made public in a code repository. (shrink)

Some claim that Non- reductive Physicalism is an unstable position, on grounds that NRP either collapses into reductive physicalism, or expands into emergentism of a robust or ‘strong’ variety. I argue that this claim is unfounded, by attention to the notion of a degree of freedom—roughly, an independent parameter needed to characterize an entity as being in a state functionally relevant to its law-governed properties and behavior. I start by distinguishing three relations that may hold between the degrees of freedom (...) needed to characterize certain special science entities, and those needed to characterize their composing physical entities; these correspond to what I call ‘reductions’, ‘restrictions’, and ‘eliminations’ in degrees of freedom. I then argue that eliminations in degrees of freedom, in particular—when strictly fewer degrees of freedom are required to characterize certain special science entities than are required to characterize their composing physical entities—provide a basis for making sense of how certain special science entities can be both physically acceptable and ontologically irreducible to physical entities. (shrink)

Most answers to the mind-body problem are claims about the nature of mental properties and substances. But advocates of non-reductive physicalism have generally neglected the topic of the nature of substance, quickly nodding to the view that all substances are physical, while focusing their intellectual energy on understanding how mental properties relate to physical ones. Let us call the view that all substances are physical or are exhaustively composed of physical substances substance physicalism (SP). Herein, I argue that non-reductive physicalism (...) (NRP) cannot uphold substance physicalism and is thereby false. For NRP faces a mind problem: its commitment to property irreducibility prevents that which bears the mental properties—the mind, or on some views, the self or person—from being a physical thing. (shrink)

Nielsen Busch and Mjaaland argue that controlled donation after circulatory death (DCD), and normothermic regional perfusion (NRP) do not violate the dead donor rule (DDR) (Nielsen Busch and Mjaala...

Jaegwon Kim, and others, have recently posed a powerful challenge to both emergentism and nom-reductive physicalism by providing arguments that these positions are committed to an untenable combination of both ‘upward’ and ‘dounward’ determination. In section 1, I illuminate how the nature of the realization relation underlies such skeptical arguments However, in section 2, I suggest that such conclusions involve a confusion between the implications of physicalism and those of a related thesis the ‘Completeness of Physics' (Co?) I show that (...) the truth of CoP poses a very serious obstacle to realized properties being efficacious in a physicalist universe and suggest that abandoning CoP offers hope for defending non-reductive physicalism. I then formulate a schema for a physicalist metaphysics, in section 3, which rejects CoP. This scenario is one where microphysical properties have a few conditional powers that they contribute to individuals when they realize certain properties In such a situation, I argue, though physicalism holds true there is still plausibly both ‘upward’ and ‘downward’ determination, where the latter is crucially an underappreciated form of determination I temn 'non- causal'. Ultimately, I conclude that this metaphysical schema offers a coherent account of Strongly emergent properties that preserves the truth of NRP albeit, in a form that is purged of any commitment to CoP. Finally, in section: 4, I carefully explore which of Kim's assumptions and arguments this metaphysics undermines. (shrink)

Some claim that Non-reductive Physicalism is an unstable position, on grounds that NRP either collapses into reductive physicalism, or expands into emergentism of a robust or ‘strong’ variety. I argue that this claim is unfounded, by attention to the notion of a degree of freedom—roughly, an independent parameter needed to characterize an entity as being in a state functionally relevant to its law-governed properties and behavior. I start by distinguishing three relations that may hold between the degrees of freedom needed (...) to characterize certain special science entities, and those needed to characterize their composing physical entities; these correspond to what I call ‘reductions’, ‘restrictions’, and ‘eliminations’ in degrees of freedom. I then argue that eliminations in degrees of freedom, in particular—when strictly fewer degrees of freedom are required to characterize certain special science entities than are required to characterize their composing physical entities—provide a basis for making sense of how certain special science entities can be both physically acceptable and ontologically irreducible to physical entities. (shrink)

The interpretation of the dead donor rule (DDR) has been central to recent debates regarding normothermic regional perfusion with controlled donation after circulatory death (NRP-cDCD). Proponents...

In transplant medicine, the use of normothermic regional perfusion (NRP) in donation after circulatory determination of death raises ethical difficulties. NRP is objectionable because it restores the donor's circulation, thus invalidating a death declaration based on the permanent cessation of circulation. NRP's defenders respond with arguments that are tortuous and factually inaccurate and depend on introducing extraneous concepts into the law. However, results comparable to NRP's—more and higher‐quality organs and more efficient allocation—can be achieved by removing organs from deceased donors (...) and using normothermic machine perfusion (NMP) to support the organs outside the body, without jeopardizing confidence in transplantation's legal and ethical foundations. Given the controversy that NRP generates and the convoluted justifications made for it, we recommend a prudential approach we call “ethical parsimony,” which holds that, in the choice between competing means of achieving a result, the ethically simpler one is to be preferred. This approach makes clear that policy‐makers should favor NMP over NRP. (shrink)

In this paper I argue that non-reductive physicalism (NRP) continues to rely on the ontological aspect of the layer cake model of the world (LCM). NRP is a post-unity account of the relationship between phenomena in the world in the sense that it has been developed in response to the perceived failure of the unity of science thesis. The LCM constitutes a framework for the organisation of phenomena in the world. It articulates the idea that phenomena in the world are (...) organised into levels. Specifically, that phenomena are layered into distinct, hierarchical levels of organisation. Historically, the unity of science thesis and the LCM have been intertwined; the LCM being the framework within which a unity of science might be possible. My argument will demonstrate that, despite a move away from unity of science positions, the LCM persists in post-unity accounts. In order to argue for this thesis, I present a close analysis of Oppenheim & Putnam’s classic presentation of the LCM; picking out the principle of hierarchic compositionality which, I argue, captures the ontological aspect of the LCM. I then demonstrate how NRP continues to rely upon the principle and, as a result, continues to support the ontological aspect of the LCM. This result is significant. It shows that whilst the rejection of the reductionist aspect of the thesis has served as the basis for post-unity positions these positions do not engage directly with the framework within which reduction might be facilitated – the LCM. Furthermore, it demonstrates that pluralist or disunity accounts of the relationship between phenomena in the world will also have to engage directly with the framework of the LCM in order to avoid being merely anti-reductionist. (shrink)

I distinguish between two phases of Rorty’s naturalism: “nonreductive physicalism” (NRP) and “pragmatic naturalism” (PN). NRP holds that the vocabulary of mental states is irreducible to that of physical states, but this irreducibility does not distinguish the mental from other irreducible vocabularies. PN differs by explicitly accepting a naturalistic argument for the transcendental status of the vocabulary of agency. Though I present some reasons for preferring PN over NRP, PN depends on whether ‘normativity’ can be ‘naturalized’.

Retrieval Induced Forgetting refers to the finding that the retrieval of some items from memory impairs the retrieval of related items. The RIF effect is indicated by a comparison of RP- with unrelated but also tobe- remembered items. Since RIF appears during intentional memorizing of words, therefore we checked whether it depends on attentional control involved in goal maintenance, and also if implicit evaluations of to-be-remembered contents moderate this process. In three experiments, each including AC as the independent variable, we (...) found AC to be related to the RIF effect. Only high but not low AC subjects showed the presence of RIF. The results of the affective priming procedure showed that implicit evaluations of NRP items moderate the relationship of high AC and the RIF effect. The explanation why temporarily devaluated NRP could enhance the RIF effect and suggestion concerning future research summarize the article. (shrink)

It was no accident that the first neuroscience community, the Neurosciences Research Program (NRP), took shape in the 1960s at MIT, the birthplace of cybernetics. Francis O. Schmitt, known as the founding father of the NRP, was a famous biologist and an avid reader of cybernetics. Focusing on the intellectual and institutional context that Schmitt was situated in, this article unveils the way that the brain was conceptualized as a distinct object, requiring the launch of a new research community in (...) the US. In doing so, this article moves beyond the dominant narratives on the triumph of molecularization of the brain at the beginning of neuroscience. Instead, it argues that what brought researchers together in the name of neuroscience was not just a molecule but an aspiration to develop biological theories of the brain/mind, which resonated with biologists in a postwar context and was materialized through support for basic research. The article highlights the tension over the computerization and molecularization of the brain, which shaped the interdisciplinary gathering of neuroscientists in the context of growing interest in basic research. Thereby, this article reveals the rise of theoretical concerns in brain science that reflect the distinct desires and concerns of biologists in the US at an intellectual and institutional level. By revisiting the launch of the NRP with a focus on Schmitt, the article sheds light on the historical contingencies in launching the new community as neuroscience in the US and their meaning for the locality and transiency of (inter)disciplinarity in brain science. (shrink)

In 1996 Varela established the neurophenomenology research programme. This project was not designed to solve what Chalmers has defined as the hard problem, but rather to offer a methodological remedy for this problem. The NRP seeks to bridge the explanatory gap by creating a reciprocal dialogue between the firstperson perspective on the one hand and third-person perspective on the other. Yet, twenty years after Varela's NRP kicked off, it seems that the explanatory gap is still very much alive. This paper (...) argues that as long as subjective experience remains at least somewhat inaccessible, we will not be able to bridge this gap. (shrink)

Combining the conceptual approach of racial formation and racial projects with the Foucauldian concept of governmentality, Jeong-eun Rhee theorizes the “neoliberal racial project” (NRP) and examines contemporary meanings and operations of race and racism in relation to neoliberalism. She analyzes Amy Chua's popular parenting memoir, Battle Hymn of the Tiger Mother, as a specific case of the NRP, and demonstrates how in this text race is pressed to work in new — neoliberal — ways, re/generating different kinds of categories and (...) meanings, yet also continuously drawing upon old categories and meanings, to effect and rationalize social arrangements of power and exploitation, violence and expropriation. What is noteworthy is the way in which racial neoliberalism builds silently on the structural conditions of racism while disabling the very categories of their recognizability. Consequently, Rhee argues for new, historically bounded theories that can articulate how the meanings, categories, and concepts of races are constantly being reconfigured. (shrink)

Background: Ethical frameworks for organ donation following circulatory death (DCD) were established >20 years ago. However, considerable variation exists among these, indicating consensus has not been reached on all issues. Additionally, advances such as cardiac DCD transplants and normothermic regional perfusion (NRP) may have reignited old debates.Methods: We reviewed the English-language literature addressing ethical issues in DCD from 1993 to 2022, examining changes in frequency with which ethical principles and their sub-themes identified within each, were addressed.Results: Non-maleficence was the most (...) frequently addressed principle (192 of 199 articles), as well as the most varied, with 9 subthemes (versus 2-4 within each of the other bioethical principles).Conclusions: There were several changes in the terminology used to refer to DCD over time, and substantial interest in cardiac DCD and NRP in recent publications, arising in 11 and 19 of the 30 publications from 2018 to 2022. (shrink)

Morris’s book is a valuable contribution. For the reasons below, I don’t think his case against NRP succeeds, and his version of EP faces a serious difficulty. Even so, this is an admirably clear, subtle, and well-informed brief, and philosophers interested in the structure of natural reality have much to gain from Morris’s insightful discussion and argumentation.

Two of the lead articles in this issue examine the emerging practice of organ procurement by normothermic regional perfusion (NRP) in terms of whether or not these patients are “dead” at the time t...

The current issue of the American Journal of Bioethics illustrates the scope of disagreement among professionals about normothermic regional perfusion (NRP). A similar range of opinions has been de...

While much of the debate around the practice of normothermic regional perfusion (NRP) is focused on the potential violation of the dead donor rule (DDR), another concern is whether allowing this pr...

Use of normothermic regional perfusion (NRP) for organ recovery in donation after circulatory death (DCD) raises two crucial, and intertwined, ethical questions. The first is whether the use of NRP...