To date ethical aspects of the use of perfusion technologies in organ donation are the subject of active discussions. The transplant community and the general public faced a return of the researchers' attention to the "initially classic" form of donation – donation of organs for transplant from deceased donors after irreversible cardiac arrest. The vulnerability of the concept of brain death is now clear due to its "industrial failure" to satisfy the request for organ transplants from medical and patient communities against the backdrop of constantly evolving types of emergency neurosurgical and neurological care, and the emerging "secondary deficit" of deceased organ donors. Thus, new ethical issues were formulated in the context of the implementation of perfusion technologies as a method of resuscitation of donor organs in the body of a deceased person and/or in the body of an intensive care patient with a sudden cardiac arrest. They are: “If it is possible to resuscitate a person?”; “What are roles and place of new technologies in the specter of resuscitation procedure?”; “When it is the precise moment to connect perfusion device?”; “Who should have the permission to connect the perfusion devices?”; “How death of a patient on an ongoing ECMO, LVAD, TAH can be verified and recorded?”. Answers to all these and many other questions yet have to be found by medical community. We presume, that the most difficult issue from the ethical and socio-humanitarian point of view is the use of ECMO-CPR in the case of ineffective CPR, where further it is necessary to carry out measures to ascertain the patient's death on the ongoing ECMO. From 2009 to the present we have carried out 35 procedures of perfusion of potential donors with 60 minutes after death record of the patient. In Russian Federation, there is a "presumed of consent". The design of this study, the protocols for perfusion, the organization procurement and the transplant procedures were approved by the Scientific Board and the Ethics Committee of the Saint Petersburg State Research Institute for Emergency (Decision 7/0615/09) and authorized for clinical application The Federal Advisory Service of the Ministry of Health of the Russian Federation (Resolution N2010/299). All donation and perfusion procedures were approved by local Ethics Committees and Institutional Review. Petersburg. According to our experience in perfusion protocols application, the most ethically approved record of patient death (potential donor) on the ongoing ECMO is the standard procedure for detecting "brain death" with the mandatory performance of cerebral angiography, and obtaining consent of the relatives for the procedure. However, this issue requires detailed consideration and discussion by the medical community.

The thesis has been prepared with the financial support of the Russian Science Foundation, Project No. 17-18-01444.