Successful Abdominal Organ Donation after Brain Death in a Patient with a Biventricular Assist Device: Extending Extended Criteria

Abstract

Few studies address the potential for donation after brain death (DBD) in the limited population of patients with ongoing mechanical circulatory support (MCS). A case study was conducted reviewing available records of both donor and recipient, and available literature. The donor was a young female with an acute myocardial infarction precipitating emergent off-pump 2-vessel bypass graft complicated by profound cardiogenic shock refractory to inotropes and intra-aortic balloon pump. A heparin drip was started following percutaneous placement of a left ventricular-assist device (TandemHeart ® ) which improved her hemodynamics to stabilize for transfer. She ultimately required surgical placement of biventricular assist device (CentraMag ® ) to normalize hemodynamics. Two days post-operatively, she developed a cerebellar hemorrhage and was declared brain dead. Pre-donation blood chemistry showed adequate end-organ function. Both kidneys were placed locally. The liver was rejected for two regional status 1 patients and by all other local centers. We accepted the liver for a patient with polycystic liver disease with a MELD exception score of 20. The recipient is now 4 years post-transplant with excellent graft function. Extending donor criteria to include MCS patients can result in successful transplantation and should be considered in selected circumstances once satisfactory donor end-organ function is established.

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

“…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.…”

“…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.…”

“…Carpenter et al ., in Phoenix, reported the case of a woman on ECMO for a cardiogenic shock after an acute myocardial infarct, who developed brain death after a cerebral hemorrhagic complication. Two kidneys and the liver were successfully transplanted into three recipients.…”