ORIGINAL RESEARCH
Transpl. Int.
Patient perspectives on the ethics and acceptability of perfusion techniques for organ transplantation: a qualitative study
- JB
Jaden Blazier 1,2,3
- EB
Eline Bunnik 3
- VK
Valerie Kortekaas 4
- EW
Esther W. de Bekker-Grob 1
- MH
Maartje H. N. Schermer 5
- NV
Niels van der Kaaij 6
- RM
Robert Minnee 7
- OM
Olivier Manintveld 8
- JD
Jeroen De Jonge 7
- EM
Emma Massey 2
1. Department of Health Technology Assessment, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
2. Department of Internal Medicine, Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
3. Department of Public Health, Program of Medical Ethics, Philosophy, and History of Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
4. Department of Philosophy and Religious Studies, Ethics Institute, Faculty of Humanities, Utrecht University, Utrecht, Netherlands
5. Department of Health Law and Ethics, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
6. Division of Cardiothoracic Surgery, Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
7. Division of HPB/Transplant Surgery, Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
8. Department of Cardiology, Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Abstract
Perfusion technologies preserve and/or improve organ viability by restoring circulation to donor organs either outside the body (machine perfusion, MP) or inside the body of the deceased donor (normothermic regional perfusion, NRP). Ethical debates surrounding perfusion raise questions about its acceptability for transplant recipients. This study explores patient perspectives on perfusion techniques and preferences regarding informed consent. Five online focus groups were conducted with 32 kidney, liver, and heart patients, both pre-and post-transplant. Sessions were analyzed using qualitative content analysis in Atlas.ti. Participants were generally accepting of MP and NRP, valuing clinical benefits. However, they were more hesitant toward NRP due to ethical concerns about post-mortem use of the donor's body and potential emotional impacts on donor families. Drivers of acceptance were patients' medical urgency and certainty that donor and donor family were respected. Most participants wanted to receive detailed information about perfusion techniques. While patients were broadly accepting of perfusion techniques, NRP raised more concerns than MP. To ensure ethical implementation and social acceptability as these technologies evolve, patient perspectives should be embedded into perfusion guidelines, informed consent processes, and policy development.
Summary
Keywords
ethics, machine perfusion, normothermic regional perfusion, Organ Transplantation, patient perspective
Received
25 February 2026
Accepted
08 June 2026
Copyright
© 2026 Blazier, Bunnik, Kortekaas, de Bekker-Grob, Schermer, van der Kaaij, Minnee, Manintveld, De Jonge and Massey. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Jaden Blazier
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.