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Many patients listed for transplantation will die before receiving an organ or become too ill for transplantation. The donor pool could be expanded by aggressive physiological support of marginal brain-dead donors or organ donation after cardiac death (DCD).
Organ ischaemia is the most important factor decreasing organ quality in DCD and some marginal brain-dead donors. Optimization of therapeutic support to maintain solid organ perfusion and oxygenation can be achieved with ECMO.
ECMO as a bridge for organ donation in brain-dead donors
Retrieval of organs often fails in brain-dead donors due to the inability to provide physiological support before, during and after the declaration of death.
Invasive haemodynamic monitoring, administration of vasoactive drugs and steroids, and hormone-replacement therapy in the potential donor are often insufficient to achieve the goals required for a safe organ procurement.
Instituting veno-arterial ECMO in unstable brain-dead donors allows organ support.
If instituted before the diagnosis of brain death, standard tests cannot be conducted. For example, the apnoea test has to be modified and requires decreasing the sweep gas flow to allow a significant rise in PaCO2.
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