Expanding the Donor Pool: Organ Donation After Brain Death for Extracorporeal Membrane Oxygenation Patients*

Christopher, Derrick A.; Woodside, Kenneth J.

doi:10.1097/ccm.0000000000002633

Cited by 5 publications

(2 citation statements)

References 14 publications

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“…DCD is now used more commonly as newer recovery and regional perfusion techniques minimize warm and cold ischemic times, including for transplanted hearts (1,(25)(26)(27)(28)(29)(30). Additionally, organs are being considered when patients receive cardiopulmonary resuscitation (CPR) (i.e., uncontrolled donation after circulatory determination of death) or ECMO for the sole purpose of donation rather than as a life-saving intervention (2,31,32). Xenotransplantation, or cross-species transplantation, is being investigated in animal models (33,34); in 2021, a kidney from a genetically modified pig was transplanted into a human recipient for the first time (35,36).…”

Section: Discussionmentioning

confidence: 99%

Organ Donation From Patients on Extracorporeal Membrane Oxygenation at the Time of Death

Fainberg

Morrison

West

et al. 2022

Critical Care Explorations

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OBJECTIVES: To describe the clinical characteristics and organ donation rate of patients supported by extracorporeal membrane oxygenation (ECMO) at the time of death. DESIGN: Retrospective observational study. Pearson chi-square and Fisher exact tests were used in statistical analyses. SETTING: One hundred twenty-seven acute care hospitals in New Jersey, Pennsylvania, and Delaware. PATIENTS: Adult and pediatric patients who were on ECMO at the time of referral to a large organ procurement organization (OPO) between 2016 and 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Nineteen thousand nine hundred thirty patients were referred to the OPO between November 2016 and September 2020, of which 5,034 were medically suitable potential donors. Of this cohort, 143 patients were supported on ECMO at the time of OPO referral and 141 were included in analyses (median age 47 yr, 60% male). Thirty-three percent (46/141, median age 48 yr, 52% male) donated organs, compared with 50% of non-ECMO patients (p ≤ 0.0005). ECMO and non-ECMO patients had organs recovered but not transplanted at similar rates (11% vs 10%, p = 0.8). There were no significant differences in sex (p = 0.16) or ethnicity (p = 0.50) between organ donor and nondonor groups. Fifty-one percent (21/41) of organ donors donated after circulatory death and 49% (20/41) after brain death. Patients declared dead by neurologic criteria were more likely to donate (51%) than those declared dead by circulatory criteria (21%, p < 0.001). Frequency of cardiac arrest prior to ECMO was similar between donors and nondonors (p = 0.68). Thirty-nine percent (16/41) of donors had an out-of-hospital cardiac arrest (OHCA) and 51% (21/41) were cannulated via extracorporeal cardiopulmonary resuscitation (ECPR). The most common reason patients were not donors was that family declined (57%). CONCLUSIONS: One-third of patients referred to the OPO on ECMO at the time of death donated organs. While donation occurred less frequently after ECMO, ECMO and non-ECMO patients had organs used rather than discarded at a similar rate. Patients successfully donated following OHCA and/or ECPR. Clinicians should not consider ECMO a barrier to organ donation.

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Section: Discussionmentioning

confidence: 99%

Organ Donation From Patients on Extracorporeal Membrane Oxygenation at the Time of Death

Fainberg

Morrison

West

et al. 2022

Critical Care Explorations

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show abstract

“…Although a lot of information is available about organs in their entirety [ 16 ], tissues are worth investigating as well for two fundamental reasons: (1) to increase and improve the actual knowledge on ECMO organs, since an organ is a complex system consisting of various tissues and the tissue functional state should allow the organ to operate high-level tasks at the best of its potentiality; (2) to reveal ECMO donors as potential new sources also for the banks of tissues, because single tissues can be harvested and used as allografts in reconstructive surgeries, e.g., valves in the heart [ 17 ], cornea in the eye [ 17 ], and ligaments/menisci in the knee [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Extra-Corporeal Membrane Oxygenation Cadaver Donors: What about Tissues Used as Allografts?

et al. 2021

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Several studies demonstrated the efficacy of post-mortem extracorporeal membrane oxygenation (ECMO) on donors in preserving organ function addressing organ transplantation. Nevertheless, no common and shared evidence was reached about the possibility of using ECMO donors in tissue harvesting. Therefore, this work aimed first to review the current scientific literature about ECMO donors, and then to focus on the use of ECMO tissues as allografts, mainly addressing musculoskeletal tissues, which are of the most interest for reconstruction. A search was conducted on the current scientific literature, focusing on the keywords “ECMO” and “Donor”. Several online databases were used, including PubMed, Scopus, and Web of Science. From the preliminary search, 478 articles were obtained, out of which 173 specifically reported the use of ECMO for donation and transplantation purposes. Literature reported extensive analyses of ECMO organs—overall from the abdomen—both in pre- and post-transplantation studies. On the other hand, ECMO tissues were explanted only in a very limited number of cases; moreover, no information was referred about their status and use. A revision of the current scientific literature highlighted the lack of information concerning ECMO tissues and the necessity to perform preclinical, ex vivo studies to compare allografts from ECMO donors, with respect to standard donors, and, thus, to verify whether they can be harvested and implanted safely and with efficacy.

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Role of ECMO in Liver Transplant

Haji

2023

Peri-Operative Anesthetic Management in Liver Transplantation

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Expanding the Donor Pool: Organ Donation After Brain Death for Extracorporeal Membrane Oxygenation Patients*

Cited by 5 publications

References 14 publications

Organ Donation From Patients on Extracorporeal Membrane Oxygenation at the Time of Death

Organ Donation From Patients on Extracorporeal Membrane Oxygenation at the Time of Death

Extra-Corporeal Membrane Oxygenation Cadaver Donors: What about Tissues Used as Allografts?

Role of ECMO in Liver Transplant

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