| Term | Definition | Temporal Nature | Purpose | Example Tools |
|---|---|---|---|---|
| Cerebral Blood Flow Testing | One-time or episodic assessment of cerebral perfusion to answer a specific diagnostic question. | Snapshot / Single time point | Diagnosis or confirmation (e.g. brain death, no cerebral perfusion in TA-NRP) | CT/MR perfusion, radionuclide scan, transcranial Doppler (spot), angiography |
| Cerebral Blood Flow Monitoring | Continuous or repeated observation of cerebral perfusion over time. | Ongoing / Real-time or repeated | Trend analysis, intraoperative safety, critical care surveillance | Continuous TCD, cerebral NIRS, brain tissue oxygen sensors |
In a Commentary/ethical analysis Lazaridis et al. from:
- University of Chicago, Chicago, IL - Hospital ClĂnic Universitari, University of Valencia, Valencia, Spain - Kutztown University of Pennsylvania, Kutztown, PA - University of Texas Southwestern Medical Center, Dallas, TX - Dartmouth Geisel School of Medicine, Hanover, NH in the Transplantation Journal argue that explicit testing and demonstration of permanent cerebral circulatory arrest are essential requirements before initiating thoracoabdominal normothermic regional perfusion (TA‑NRP) protocols, ensuring compliance with the dead‑donor rule and safeguarding ethical validity.
Authors insist that without rigorous brain blood flow testing, TA‑NRP risks unethical resuscitation of brain circulation, undermining the declaration of death.
This commentary is rhetorically forceful but methodologically weak. It lacks empirical data demonstrating that cerebral reperfusion actually occurs in current TA‑NRP practice. Its ethical argument builds on slippery slopes (“may restore brain perfusion”) without quantified incidence or objective testing results. The authors extrapolate from theoretical risk rather than documented case series. They fail to engage with current techniques employing cerebral vessel clamping or surgical safeguards, which multiple other groups have shown prevent cerebral reperfusion :contentReference[oaicite:0]{index=0}. Instead, Lazaridis et al. redundantly reassert 2022–2023 ethical debates without adding new experimental evidence or risk quantification. They ignore logistical constraints and potential false positives inherent to brain flow monitoring modalities. Their interpretation assumes that absent brain flow testing equates to likely reperfusion, yet no data support that contingency in practice. Overall, the argument is alarmist, philosophically anchored in uncertainty rather than scientific demonstration.
Overstated and unsupported commentary; fails to advance evidence or practice.
Neurosurgeons should demand empirical studies documenting cerebral flow absence during TA‑NRP before endorsing routine mandates for invasive brain perfusion testing.
Ethical speculation dressed as urgent call‑to‑arms—premature and lacking substantiation.
3/10
Christos Lazaridis et al. *The Necessity of Brain Blood Flow Testing in Thoracoabdominal Normothermic Regional Perfusion.* Transplantation. Online ahead of print 24 June 2025. doi: 10.1097/TP.0000000000005472. PMID: 40551304. Corresponding author email: lazaridis@uchicagomedicine.org ~~~~