Wynne Morrison, MD, MBE,FCCM
Director of the Justin Michael Ingerman Center for Palliative Care
Childrens Hospital of Philadelphia
Cherry Hill, New Jersey, United States
Disclosure information not submitted.
Sharon West, MS
Director of Donation and Transplantation Analytics
Gift of Life Donor Program, United States
Disclosure information not submitted.
Richard Hasz, BS, MSFS
Vice President of Clinical Services
Gift of Life Donor Program, United States
Disclosure information not submitted.
Matthew Kirschen, MD, PhD
Assistant Professor of Anesthesia and Critical Care Medicine, Pediatrics, and Neurology
Childrens Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Title: Organ Donation on ECMO: A Descriptive Analysis of an Organ Procurement Organization Database
Introduction: The need for transplantable organs outweighs the supply, leading institutions to consider unconventional donors. Centers have demonstrated normal or near-normal allograft function from patients who donated organs supported by extracorporeal membrane oxygenation (ECMO). The objective was to describe the demographics and clinical characteristics of organ donors supported by ECMO at the time of referral to a regional organ procurement organization (OPO).
Methods: Retrospective descriptive analysis of patients in a regional OPO database who were on ECMO at the time of OPO referral between 2016 and 2020. Demographics and clinical characteristics were reported for patients who donated organs and those who did not. Pearson’s Chi-squared test and Fischer’s exact test were used for statistical analysis.
Results: 143 patients were screened, and 141 met inclusion criteria. Two patients were excluded due to insufficient information in the chart or prolonged time between ECMO decannulation and death. 33% (46/141) of ECMO patients were organ donors and donated a total of 77 organs. Of the donors, 11% (5/46) had organs recovered but not transplanted, and were treated as non-donors in the remainder of analyses. There were no significant differences in sex (p=0.16) or ethnicity (p=0.50) between the organ donor and non-donor groups. 51% (21/41) of organ donors donated after circulatory death, and 49% (20/41) after brain death. 63% (26/41) and 61% (61/100) had a cardiac arrest prior to ECMO in the donor and non-donor groups, respectively (p=0.16). 39% (16/41) of donors had an out-of-hospital cardiac arrest and 51% (21/41) were cannulated via extracorporeal cardiopulmonary resuscitation (ECPR). The most common reason that patients were not donors was that family declined (57%). One (1%) patient was declined by the medical examiner.
Conclusions: One-third of patients on ECMO at the time of referral to a regional OPO were organ donors. Donors and non-donors had similar demographic features. Twenty-one patients successfully donated following ECMO cannulation via ECPR. Clinicians should not consider ECMO as a barrier to organ donation.