1General Surgery, University of Michigan Health System, Ann Arbor, Michigan.
Background: We have initiated a non-heart-beating (NHB) donor program using extracorporeal membrane oxygenation (ECMO) as a means to not only decrease warm ischemic times, but also to resuscitate and restore normal hemodynamics during NHB donation.
Purpose: To describe the technique for ECMO-supported NHB organ donation and to review donor characteristics.
Methods: Normothermic, venous-arterial ECMO was used to preserve normal hemodynamics after confirmation of cardio-pulmonary death in 5 NHB organ donor candidates. A retrospective chart review was performed of ECMO-specific parameters and donor characteristics.
Results: The donor group comprised 3 males and 2 females, with an age range of 17 to 45 yrs. Eighty percent became severely brain injured as a result of a closed head injury. The median time required to place the ECMO cannulas was 45 mins (range 40 to 63 mins). All patients succumbed to cardio-pulmonary demise within 13 mins of extubation. The ECMO circuit was started at the declaration of donor death, after cannulas were placed while the donor still had cardiac function. Once started, the ECMO circuit continued until the patient was brought to the operating room and aortic cross-clamping was performed. Surgical procurement then commenced as in a routine heart-beating donor.
Conclusions: The use of ECMO support during NHB organ donation has many advantages as compared to standard flush techniques, the most pertinent being the ability to restore normal hemodynamics and perfusion to transplantable organs prior to procurement.