Extracorporeal Support for Organ Donation after Cardiac Death Effectively Expands the Donor Pool

Magliocca, Joseph F.; Magee, John C.; Rowe, Stephen A.; Gravel, Mark T.; Chenault, Richard; Merion, Robert M.; Punch, Jeffrey D.; Bartlett, Robert H.; Hemmila, Mark R.

doi:10.1097/01.ta.0000169949.82778.df

Cited by 211 publications

(165 citation statements)

References 22 publications

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“…In situ extracorporeal perfusion is initiated 5 minutes after cardiorespiratory arrest of donors in order to preserve organs for procurement. 25 Coronary and cerebral reperfusion can lead to the return of cardiac and neurologic functions (also called reanimation) of donors during the procurement process. Mechanical occlusion of the aortic arch and pharmacological agents are required to suppress donor reanimation during organ procurement.…”

Section: Federal Regulations ‡mentioning

confidence: 99%

“Non‐heart‐beating,” or “cardiac death,” organ donation: Why we should care

Rady

Verheijde

McGregor

2007

Journal of Hospital Medicine

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BACKGROUNDOrgan donation after cessation of cardiac pump activity is referred to as non‐heart‐beating organ donation (NHBOD). NHBOD donors can be neurologically intact; they do not fulfill the brain death criteria prior to cessation of cardiac pump activity. For hospitals to participate in NHBOD, they must comply with a newly introduced federal requirement for ICU patients whose deaths are considered imminent after withdrawal of life support. This report describes issues related to NHBOD.METHODSA nonstructured review of selected publications and Web sites was undertaken.RESULTSScientific evidence from autoresuscitation and extracorporeal perfusion suggests that verifying cardiorespiratory arrest lasting 2–5 minutes does not uniformly comply with the dead donor rule, so that the process of organ procurement can be the irreversible event defining death in organ donors. The interest of organ procurement organizations and affiliates in maximizing recovery of transplantable organs introduces self‐serving bias in gaining consent for organ donation and abandons the basic tenet of obtaining true informed consent. The impact of donor management and procurement protocols on end‐of‐life (EOL) care and the potential trade‐off are not disclosed, raising concern about whether potential donors and their families are fully informed before consenting to donation.CONCLUSIONSThe use of comprehensive quality indicators for EOL care can determine the impact of NHBOD on care offered to donors and the effects on families and health care providers. Detailed evaluation of NHBOD will enable the public to make informed decisions about participating in this type of organ donation. Journal of Hospital Medicine 2007;2:324–334. © 2007 Society of Hospital Medicine.

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Section: Federal Regulations ‡mentioning

confidence: 99%

“Non‐heart‐beating,” or “cardiac death,” organ donation: Why we should care

Rady

Verheijde

McGregor

2007

Journal of Hospital Medicine

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“…Once the abdomen is opened surgically and organ preservation solution is introduced, ECMO is discontinued. 18 Uncontrolled DCD proceeds in a less structured manner, in part because the process usually begins in the field. In the simplest prehospital protocol, after death is declared per usual standards, paramedics continue cardiopulmonary resuscitation (CPR) to continue perfusing the organs while the patient is transported to a transplant center.…”

Section: The Dcd Processmentioning

confidence: 99%

“…Notably, if cardiac activity does not cease within a specified time (usually 1 to 2 hours), the patient is returned to the ICU for terminal care. 18 Once death is declared, the procurement team begins all relevant processes to maximize the quality and quantity of organs that can be obtained. One particular technique for organ preservation in potential DCD donors worth mentioning, especially as it may begin prior to the declaration of death, is extracorporeal membrane oxygenation (ECMO).…”

Section: The Dcd Processmentioning

confidence: 99%

Donation After Cardiac Death and the Emergency Department: Ethical Issues

Simon

Schears

Padela

2014

Academic Emergency Medicine

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“…Description of cDCDD protocols using ECMO and an aortic balloon The University of Michigan protocol (1,10) provides that after family members and health professionals agree to W-LST, the option of cDCDD is offered to the family. With consent, ECMO cannulas are inserted with a deflated supradiaphragmatic aortic occlusion balloon.…”

Section: Consentmentioning

confidence: 99%

“…Programs for controlled donation after circulatory determination of death (cDCDD) have been developed to increase the pool of organs for transplantation (1). Donation occurs once death has been determined following withdrawal of life-sustaining therapy (W-LST).…”

Section: Introductionmentioning

confidence: 99%

Ethical Issues in the Use of Extracorporeal Membrane Oxygenation in Controlled Donation After Circulatory Determination of Death

Ave¹,

Shaw

Bernat

2016

American Journal of Transplantation

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The use of donor extracorporeal membrane oxygenation (ECMO) to improve graft outcomes by some controlled donation after circulatory determination of death (cDCDD) programs raises ethical issues. We reviewed cDCDD protocols using ECMO and the relevant ethics literature to analyze these issues. It is not obvious that ECMO in cDCDD improves graft outcomes. In our opinion, ECMO implemented before death can interfere with end-of-life care and damage bodily integrity. By restoring systemic circulation, ECMO risks invalidating the preceding declaration of death if brain and cardiac perfusion is not adequately excluded because of malfunction or misplacement of the supradiaphragmatic aortic occlusion balloon. The use of ECMO is not compatible with the acronym DCDD because circulation is restored after the determination of death. Because of these deficiencies, we concluded that other techniques are preferable, such as rapid recovery or in situ cold infusion. If ECMO is performed, it requires a specific informed consent and transparency.Abbreviations: cDCDD, controlled donation after circulatory determination of death; DBDD, donation after brain determination of death; DBTL, doubleballoon triple-lumen; DCDD, donation after circulatory determination of death; DDR, dead donor rule;

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Extracorporeal Support for Organ Donation after Cardiac Death Effectively Expands the Donor Pool

Abstract: The implementation of a DCD protocol using extracorporeal perfusion increased the potential organ donor pool at our institution by 33%. This was accomplished without short term adverse effect on organ function compared with kidneys transplanted from DBD donors.

Cited by 211 publications

References 22 publications

“Non‐heart‐beating,” or “cardiac death,” organ donation: Why we should care

“Non‐heart‐beating,” or “cardiac death,” organ donation: Why we should care

Donation After Cardiac Death and the Emergency Department: Ethical Issues

Ethical Issues in the Use of Extracorporeal Membrane Oxygenation in Controlled Donation After Circulatory Determination of Death

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