Extracorporeal membrane oxygenation in brain-death organ and tissues donors: a single-centre experience

Migliaccio, Maria Luisa; Zagli, Giovanni; Cianchi, Giovanni; Lazzeri, Chiara; Bonizzoli, Manuela; Cecchi, Adriana; Anichini, V; Gensini, Gian Franco; Peris, Adriano

doi:10.1093/bja/aet323

Cited by 34 publications

(30 citation statements)

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“…Fondevila et al and Savier et al have successfully used NRP in 34 and 13 uncontrolled DCD LTs, respectively, with a no‐touch period of 5 minutes . On the other hand, Carter et al have reported 15 LTs from ECMO‐supported DBD donors with a 1‐year graft survival of 93%, and several other studies report similar results . Although some authors have hypothesized that ECMO‐supported DBD may display the same physiology as DCD on NRP, these 2 methods differ considerably from each other in 3 main areas.…”

Section: Discussionmentioning

confidence: 98%

“…(9,27) On the other hand, Carter et al have reported 15 LTs from ECMOsupported DBD donors with a 1-year graft survival of 93%, and several other studies report similar results. (4)(5)(6)(7) Although some authors have hypothesized that ECMOsupported DBD may display the same physiology as DCD on NRP, (5,7) these 2 methods differ considerably from each other in 3 main areas. First, circulatory death precedes NRP, whereas brain death is assessed during ECMO.…”

Section: Original Article | 1531mentioning

confidence: 99%

“…(1)(2)(3) Extracorporeal membrane oxygenation (ECMO) is increasingly used for support of patients with overwhelming cardiac failure, and some investigators have reported successful liver transplantations (LTs) from donation after brain death (DBD) during ECMO. (4)(5)(6)(7) In DCD, normothermic regional perfusion (NRP) based on ECMO technology has proven effective for improving transplant outcomes and allowing use of uncontrolled donors. (8,9) In addition to its reconditioning properties, NRP also offers the possibility to assess graft function after warm ischemia.…”

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confidence: 99%

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Liver Grafts From Donors After Circulatory Death on Regional Perfusion With Extended Warm Ischemia Compared With Donors After Brain Death

et al. 2018

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Donation after circulatory death (DCD) in Italy constitutes a relatively unique population because of the requirement of a no-touch period of 20 minutes. The first aim of this study was to compare liver transplantations from donors who were maintained on normothermic regional perfusion after circulatory death and suffered extended warm ischemia (DCD group, n = 20) with those from donors who were maintained on extracorporeal membrane oxygenation (ECMO) and succumbed to brain death (ECMO group, n = 17) and those from standard donors after brain death (donation after brain death [DBD] group, n = 52). Second, we conducted an explorative analysis on the DCD group to identify relationships between the donor characteristics and the transplant outcomes. The 1-year patient survival for the DCD group (95%) was not significantly different from that of the ECMO group (87%; P = 0.47) or the DBD group (94%; P = 0.94). Graft survival was slightly inferior in the DCD group (85%) because of a high rate of primary nonfunction (10%) and retransplantation (15%) but was not significantly different from the ECMO group (87%; P = 0.76) or the DBD group (91%; P = 0.20). Although ischemic cholangiopathy was more frequent in the DCD group (10%), this issue did not adversely impact graft survival because none of the recipients underwent retransplantation due to biliary complications. Moreover, the DCD recipients were more likely to develop posttransplant renal dysfunction with the need for renal replacement therapy. Further analysis of the DCD group showed that warm ischemia >125 minutes and an Ishak fibrosis score of 1 at liver biopsy negatively impacted serum creatinine and alanine transaminase levels in the first posttransplant week, respectively. In conclusion, our findings encourage the use of liver grafts from DCD donors maintained by regional perfusion after proper selection.

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Section: Discussionmentioning

confidence: 98%

Section: Original Article | 1531mentioning

confidence: 99%

mentioning

confidence: 99%

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Liver Grafts From Donors After Circulatory Death on Regional Perfusion With Extended Warm Ischemia Compared With Donors After Brain Death

et al. 2018

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“…After a PubMed and Google Scholar search using key words including ECMO, extracorporeal support, brain dead and brain death, we were able to find only 11 case reports or case series . It was often unclear whether ECMO was implemented before, during or after brain death testing, making interpretation difficult.…”

Section: Guidelines and Case Reportsmentioning

confidence: 99%

The ethics of extracorporeal membrane oxygenation in brain-dead potential organ donors

Ave¹,

Gardiner

Shaw

2016

Transpl Int

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SUMMARYOrgan-preserving extracorporeal membrane oxygenation (OP-ECMO) is defined as the use of extracorporeal support for the primary purpose of preserving organs for transplantation, rather than to save the patient's life. This paper discusses the ethics of using OP-ECMO in donation after brain determination of death (DBDD) to avoid the loss of organs for transplantation. We review case reports in the literature and analyze the ethical issues raised. We conclude that there is little additional ethical concern in continuing OP-ECMO in patients already on ECMO if they become brain dead. The implementation of OP-ECMO in hemodynamically unstable brain-dead patients is ethically permissible in certain clinical situations but requires specific consent from relatives if the patient's wish to donate is not clear. If no evidence of a patient's wish to donate is available, OP-ECMO is not recommended. In countries with presumed consent legislation, failure to opt out should be considered as a positive wish to donate. If a patient is not-yet brain-dead or is undergoing testing for brain death, OP-ECMO is not recommended. Further research on OP-ECMO is needed to better understand the attitudes of professionals, families, and lay people to ensure agreement on key ethical issues.

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“…5 There have been even fewer reports of ECMO used not with therapeutic intent, but to support and maintain the patient's organs for transplant if brain death, cardiac arrest, or circulatory collapse takes place before organ retrieval can occur. 6,7 One such study 7 reported on 4 donors treated with ECMO for 9.5 to 78.0 hours before their death. Two of the 8 kidneys could not be used (discard rate, 25%), and the other 6 were successfully transplanted (DGF rate, 33%).…”

Section: Introductionmentioning

confidence: 99%

Immediately Functioning Grafts from Brain-Dead Donors Treated with Extracorporeal Membrane Oxygenation

Shaheen

Shalabi²,

Zain³

et al. 2019

Exp Clin Transplant

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A brain-dead donor experienced repeated cardiac arrests followed by severe hypotension requiring multiple vasoactive agents. These events were associated with severe lactic acidosis and dysregulated kidney function in the donor. A 10-hour treatment with extracorporeal membranous oxygenation was instituted, which was able to hemodynamically stabilize the donor. This treatment protocol resulted in the procurement of 2 viable kidney grafts transplanted into 2 recipients, who had immediate kidney graft function and excellent serum creatinine levels upon hospital discharge. These results are all the more significant considering that both cases involved long cold ischemia times, and one of the recipients had diabetes and was receiving his second kidney graft.

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Extracorporeal membrane oxygenation in brain-death organ and tissues donors: a single-centre experience

Cited by 34 publications

References 1 publication

Liver Grafts From Donors After Circulatory Death on Regional Perfusion With Extended Warm Ischemia Compared With Donors After Brain Death

Liver Grafts From Donors After Circulatory Death on Regional Perfusion With Extended Warm Ischemia Compared With Donors After Brain Death

The ethics of extracorporeal membrane oxygenation in brain-dead potential organ donors

Immediately Functioning Grafts from Brain-Dead Donors Treated with Extracorporeal Membrane Oxygenation

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