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

Abstract

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.

Extracorporeal membrane oxygenation and effects on tendon tissue: A vibrational spectroscopy study

“…Nevertheless, although clinical reports have shown that pretransplant biopsies can support clinicians in assessing the quality of organs [2][3][4], ECMO effects on tissue, especially on musculoskeletal tissues, have not been fully clarified. Therefore, in agreement with Marchiori et al [5], to verify the safety and effectiveness, tissues harvested from ECMO donors should be compared with those coming from standard donors by defining specific ex vivo experiments. To this aim, together with the most common histological analyses and mechanical testing, vibrational spectroscopic techniques based on light-scattering may help researchers to achieve new insights into the molecular and structural modifications of tissues subjected to ECMO procedures.…”

“…In this respect, Fourier transform infrared (FTIR) and Raman spectroscopies have been extensively used to characterize a variety of biological tissues, demonstrating their ability to accurately describe tissue composition and detect biochemical changes associated with pathologies [5,6]. There has recently been evidence that vibrational spectroscopic techniques can provide useful information about the effects of physical/chemical pretreatments, such as gamma irradiation, surfactant de-cellularization, and supercritical carbon dioxide treatment, on allogeneic tendons intended for transplants [7], thus providing clinicians with effective decision support.…”

Vascularization in Bioartificial Parenchymal Tissue: Bioink and Bioprinting Strategies

“…A critical global shortage of donor organs requires the development of alternative treatment strategies [ 1 ]. Even though current research provides opportunities to extend the donation pool to post mortem donation after unexpected circulatory death by extracorporeal membrane oxygenation (ECMO), there is still a supply and demand mismatch [ 2 , 3 ]. Tissue engineering envisions potentially replacing or rather supplementing the current gold-standard allograft tissue transplantation and manufacturing logistic templates for cell therapy [ 1 , 4 ].…”

Challenges in the Extracorporeal Membrane Oxygenation Era

“…Following this pathway, a thorough evaluation of contraindications to extracorporeal gas exchange [5] (reducing year by year), the principles of prognostication during ECMO [6] and the use of ECMO in thoracic surgery have been explored [7]. An interesting review by Marchiori et al reviewed the current scientific literature about ECMO donors, focusing on the use of ECMO tissues as allografts [8]-a topic that will be probably become relevant in the next years. As an ideal conclusion of this chapter, two original studies focused on outcomes of ARDS patients supported by ECMO; Chiu [9] showed that propensity score-matched ARDS patients treated with ECMO are more likely to survive than patients on conventional protective mechanical ventilation, and this benefit seemed greater for the most severe patients and when the extracorporeal support was initiated early (i.e., within 48 h); Martucci and colleagues [10] defined a set of microRNAs which may provide new insights on the processes involved in the pathogenesis and evolution of ARDS and may represent promising biomarkers to evaluate ongoing treatments and for prognostication.…”