Patient with liver dysfunction while maintained on veno-venous extracorporeal membrane oxygenation should not be overlooked as a potential donor

Abstract

Summary This report describes transplantation of liver allograft from a circulatory death donor who was supported by veno‐venous extracorporeal membrane oxygenation (ECMO) for 14 days and presented with severely altered liver functions. Successful liver transplant was done in a patient with hepatocellular carcinoma (HCC) in the background of primary sclerosing cholangitis. There was immediate graft function and uneventful recovery with stable graft function at 1‐year follow‐up. This case illustrates the ability of veno‐venous ECMO to resuscitate organs in the presence of severe dysfunction, and perhaps, lessons from this case may be incorporated to optimize the condition of organs rescued from these marginal donors and exemplify the use of ECMO in normothermic regional perfusion in donors after circulatory death.

Early Clinical Results Using Normothermic Machine Liver Preservation

“…Therapeutically intended ECMO therapy before declaration of death has not been considered a contraindication for organ donation. It has shown comparable results to conventional graft procurement under heart beating conditions [46,47]. Initiating ECMO recirculation directly after controlled cardiac arrest in an intensive care unit setting has been described by Magliocca et al from the University of Michigan [48].…”