The organ preservation and enhancement of donation success ratio effect of extracorporeal membrane oxygenation in circulatory unstable brain death donor

Abstract

Between 2010 and 2013, we recorded 66 cases of failed organ donation after brain death (DBD) due to the excessive use of the vasoactive drugs resulting in impaired hepatic and/or renal function. To investigate the effect of extracorporeal membrane oxygenation (ECMO) in donor management, ECMO was used to provide support for DBD donors with circulatory and/or respiratory failure from 2013 to 2015. A retrospective cohort study between circulatory non-stable DBD with vasoactive drugs (DBD-drug) and circulatory non-stable DBD with ECMO (DBD-ECMO) was designed to compare the transplant outcomes. A total of 19 brain death donors were supported by ECMO. The incidence rate of post-transplant liver primary non-function (PNF) was 10% (two of 20) in DBD-drug group and zero in DBD-ECMO group. Kidney function indicators, including creatinine clearance and urine production, were significantly better in DBD-ECMO group, as well as the kidney delayed graft function (DGF) rate was found to be decreased by the use of ECMO in our study. Donation success rate increased steadily from 47.8% in 2011 to 84.6% in 2014 after the ECMO intervention. The use of ECMO in assisting circulatory and respiratory function of DBD can reduce liver and kidney injury from vasoactive drugs, thereby improving organ quality and reducing the organ discard rates.

Successful extracorporeal membrane oxygenation transport of a 4‐month‐old brain‐dead infant for organ donation: A case report

“…They concluded that even though donors undergoing ECMO had more severe medical conditions, their organs' survival and function were similar to those from donors without ECMO . Two different scenarios for ECMO use in organ donation should be distinguished: (a) organ recovery from a brain‐dead donor initiated on ECMO prior to brain death and (b) the use of ECMO after the diagnosis of brain death to stabilize a potential donor to achieve organ recovery . Our case illustrated the first (a) scenario described above, whereas Isnardi et al reported a case similar to the second (b) described scenario: They initiated ECMO 50 minutes after declaration of brain death as a bridge to organ donation in a 14‐year‐old adolescent .…”

“…2 Two different scenarios for ECMO use in organ donation should be distinguished: (a) organ recovery from a F I G U R E 1 Patient installation before transport brain-dead donor initiated on ECMO prior to brain death and (b) the use of ECMO after the diagnosis of brain death to stabilize a potential donor to achieve organ recovery. 8,9 Our case illustrated the first (a) scenario described above, whereas Isnardi et al reported a case similar to the second (b) described scenario: They initiated ECMO 50 minutes after declaration of brain death as a bridge to organ donation in a 14-year-old adolescent. 5 This use of ECMO after the diagnosis of brain death requires consideration regarding ethical and management aspects as it seriously compromises standard duties of care to the dying child.…”

Preliminary experience of sequential use of normothermic and hypothermic oxygenated perfusion for donation after circulatory death kidney with warm ischemia time over the conventional criteria - a retrospective and observational study

“…On the other hand, the lactate value evaluated during NRP was not related to PNF and DGF, so it may not be considered a contraindication to the use of the graft in our preliminary experience . At the same time, sCr level and anuria during NRP, considering that all our donors had anuria, may not be considered absolute criteria for discarding the kidneys, as instead suggested by other authors .…”

An approach to diagnosing brain death in patients undergoing extracorporeal membrane oxygenation

“…It was added that ECMO-treated patients who were diagnosed with brain death can also make good donors [18]. In another study, Fan et al [19] regarded ECMO as a step for preserving organs of patients diagnosed with brain death; consequently, they reported improved results on liver and kidney transplantation (an increase from 47.8% to 84.6%). Moreover, in case presentations by Lee et al [20].…”