Extracorporeal Membrane Oxygenation Support in Potential Organ Donors for Brain Death Determination

Hsieh, Chia-En; Lin, HY; Tsui, Y.-C.; Lin, Ping‐Yi; Lin, Kun-Te; Chang, Yen-Yu; Chen, Y.-L.

doi:10.1016/j.transproceed.2011.06.027

Cited by 31 publications

(35 citation statements)

References 6 publications

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“…The procurement and sustained function of organs from ECMO non-survivors is a distinct benefit to be gained from ECMO, as reported previously by our group and others [24][25][26]. Results from our current study demonstrated the efficacy of E-CPR in also allowing organs to be harvested for transplantation in patients who have suffered an anoxic brain injury.…”

Section: Discussionsupporting

confidence: 82%

Saving life and brain with extracorporeal cardiopulmonary resuscitation: A single-center analysis of in-hospital cardiac arrests

Peigh

Cavarocchi

Hirose

2015

The Journal of Thoracic and Cardiovascular Surgery

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Section: Discussionsupporting

confidence: 82%

Saving life and brain with extracorporeal cardiopulmonary resuscitation: A single-center analysis of in-hospital cardiac arrests

Peigh

Cavarocchi

Hirose

2015

The Journal of Thoracic and Cardiovascular Surgery

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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 use of OP‐ECMO before the declaration of brain death, as described in some case reports , is problematic. First, ECMO increases the potential risks of intracranial bleeding and therefore could, in a not‐yet brain‐dead patient, hasten death.…”

Section: Ethical Analysis Of Op‐ecmomentioning

confidence: 99%

“…We could find no published guidelines concerning the implementation of OP-ECMO in hemodynamically unstable brain-dead potential organ donors or concerning the ongoing use of ECMO in patients who develop brain death. 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 [15][16][17][18][19][20][21][22][23][24][25]. 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%

“…Our literature review shows that there is very little evidence concerning recipient survival and graft function outcomes when organ donors were hemodynamically sustained by ECMO. However, the aforementioned case reports regarding use of OP-ECMO provide encouraging results [23,24]. Good graft outcomes in recipients are also reported when donors were under therapeutic ECMO before brain death [18].…”

Section: Guidelines and Case Reportsmentioning

confidence: 99%

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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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Using extracorporeal membrane oxygenation in donations after cardiac death or brain death: A single‐center experience and long‐term outcome

Hsieh,

Hsu,

Chen

et al. 2023

Annals of Gastroent Surgery

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AimsThe use of extended criteria donors is a routine practice that sometimes involves extracorporeal membrane oxygenation (ECMO) in donations after cardiac death or brain death.MethodsWe performed a retrospective study in a single center from January 2006 to December 2019. The study included 90 deceased donor liver transplants. The patients were divided into three groups: the donation after brain death (DBD) group (n = 58, 64.4%), the DBD with ECMO group (n = 11, 12.2%) and the donation after cardiac death (DCD) with ECMO group (n = 21, 23.3%).ResultsThere were no significant differences between the DBD with ECMO group and the DBD group. When comparing the DCD with ECMO group and the DBD group, there were statistically significant differences for total warm ischemia time (p < 0.001), total cold ischemia time (p = 0.023), and split liver transplantation (p < 0.001), and there was significantly poor recovery in regard to total bilirubin level (p = 0.027) for the DCD with ECMO group by repeated measures ANOVA. The 5‐year survival rates of the DBD, DBD with ECMO, and DCD with ECMO groups were 78.1%, 90.9%, and 75.6%, respectively. The survival rate was not significantly different when comparing the DBD group to either the DBD with ECMO group (p = 0.435) or the DCD with ECMO group (p = 0.310).ConclusionsUsing ECMO in donations after cardiac death or brain death is a good technology, and it contributed to 35.6% of the liver graft pool.

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Extracorporeal Membrane Oxygenation Support in Potential Organ Donors for Brain Death Determination

Cited by 31 publications

References 6 publications

Saving life and brain with extracorporeal cardiopulmonary resuscitation: A single-center analysis of in-hospital cardiac arrests

Saving life and brain with extracorporeal cardiopulmonary resuscitation: A single-center analysis of in-hospital cardiac arrests

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

Using extracorporeal membrane oxygenation in donations after cardiac death or brain death: A single‐center experience and long‐term outcome

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