Novel metalinguistic approach to declaring circulatory death in normothermic regional perfusion: a lesson from brain death

Recent advancements in organ procurement techniques to improve the quality of donated organs have given rise to normothermic regional perfusion (NRP), a procedure that restores blood flow to organs in patients who are declared dead by the circulatory standard. Arguments about NRP often refer to a troubling question: are NRP donors truly dead, or are they resuscitated? Such concerns about NRP draw parallels to the brain death debate: an issue that has attracted irreconcilable arguments about the nature of death. The resulting ideological gridlock seems to suggest that death is a metaphysical concept based on deeply rooted philosophical beliefs, and engaging in more intractable debates about the nature of death seems unfruitful for bioethics. In order to avoid repeating the mistakes of the brain death debate, metaphysical arguments about circulatory death should be framed under a new paradigm of metalinguistic dispute . This paradigm considers how the concept of ‘death’ should be deployed usefully for NRP by evaluating the sociofunctional consequences of deploying death concepts for NRP while leaving the metaphysical question about death open. This paradigmatic shift from metaphysics to metalinguistics can help clinicians focus on clarifying the pragmatic and moral significance of declaring someone dead before undergoing NRP according to each patient’s beliefs about death. A choice-based policy aligns with this goal by circumventing an ideological gridlock and avoiding the imposition of a single metaphysical conclusion about NRP on families with diverging beliefs about death.