Mobile ECMO team for controlled donation after circulatory death

Pérez-Villares, J.M.; Lara-Rosales, R.; Fernández-Carmona, A.; Fuentes-García, P.; Burgos-Fuentes, Manuel; Baquedano-Fernández, Blas

doi:10.1111/ajt.14656

Cited by 15 publications

(3 citation statements)

References 4 publications

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“…Several approaches have been developed to facilitate the implementation of NRP across a number of legal and organizational settings. 14,31 As such, the use of NRP is routine in Spain (where comparable liver and kidney outcomes have been reported 32 ) and is mandated for liver recovery in France and Italy. In other countries such as the United Kingdom, Sweden, the Netherlands, and Switzerland, the use of NRP is expanding, with a clear need for a well-funded and well-designed infrastructure including establishing a dedicated Advanced Perfusion and Organ Preservation Specialist role to support the NRP and other novel perfusion technologies.…”

Section: Discussionmentioning

confidence: 99%

Improved Organ Utilization and Better Transplant Outcomes With In Situ Normothermic Regional Perfusion in Controlled Donation After Circulatory Death

et al. 2023

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Background . We evaluated whether the use of normothermic regional perfusion (NRP) was associated with increased organ recovery and improved transplant outcomes from controlled donation after circulatory death (cDCD). Methods . This is a retrospective analysis of UK adult cDCD donors‚ where at least 1 abdominal organ was accepted for transplantation between January 1, 2011, and December 31, 2019. Results . A mean of 3.3 organs was transplanted when NRP was used compared with 2.6 organs per donor when NRP was not used. When adjusting for organ-specific donor risk profiles, the use of NRP increased the odds of all abdominal organs being transplanted by 3-fold for liver (P < 0.0001; 95% confidence interval [CI], 2.20-4.29), 1.5-fold for kidney (P = 0.12; 95% CI, 0.87-2.58), and 1.6-fold for pancreas (P = 0.0611; 95% CI, 0.98-2.64). Twelve-mo liver transplant survival was superior for recipients of a cDCD NRP graft with a 51% lower risk-adjusted hazard of transplant failure (HR = 0.494). In risk-adjusted analyses, NRP kidneys had a 35% lower chance of developing delayed graft function than non-NRP kidneys (odds ratio, 0.65; 95% CI, 0.465-0.901)‚ and the expected 12-mo estimated glomerular filtration rate was 6.3 mL/min/1.73 m2 better if abdominal NRP was used (P < 0.0001). Conclusions . The use of NRP during DCD organ recovery leads to increased organ utilization and improved transplant outcomes compared with conventional organ recovery.

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Section: Discussionmentioning

confidence: 99%

Improved Organ Utilization and Better Transplant Outcomes With In Situ Normothermic Regional Perfusion in Controlled Donation After Circulatory Death

et al. 2023

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“…Although no cases of livers donated from DCD donors supported by ECMO have been reported for paediatric recipients, one DBD case was successfully transplanted [48]. In addition, the availability of a mobile ECMO team could enable the use of this technology in smaller hospitals, as recently demonstrated by authors in Spain [64].…”

Section: The Potential Role Of Machine Perfusion In Dcd Liver Transpl...mentioning

confidence: 91%

Donation after Circulatory Death Liver Transplantation in Paediatric Recipients

et al. 2022

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Waiting list mortality together, with limited availability of organs, are one of the major challenges in liver transplantation (LT). Especially in the paediatric population, another limiting factor is the scarcity of transplantable liver grafts due to additional concerns regarding graft size matching. In adults, donation after circulatory death (DCD) liver grafts have been used to expand the donor pool with satisfactory results. Although several studies suggest that DCD livers could also be used in paediatric recipients with good outcomes, their utilisation in children is still limited to a small number of reports. Novel organ perfusion strategies could be used to improve organ quality and help to increase the number of DCD grafts utilised for children. With the current manuscript, we present the available literature of LT using DCD grafts in paediatric recipients, discussing current challenges with the use of these livers in children and how machine perfusion technologies could be of impact in the future.

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“…In Spain in 2016, 18% of all deceased donations were controlled donations with organ-preserving ECMO after circulatory death. 8 With the shortage of donors, ethical donation is feasible and should be considered. 9 Certainly, the ethical use of ECMO in these situations-organ harvest as a consequence versus the goal-requires thoughtful deliberation.…”

mentioning

confidence: 99%