Heart-Beating and Non-Heart-Beating Donors

Abstract

Organ transplantation is limited by the shortage of viable donor organs. Non-heart-beating donors (NHBD), also frequently referred to as donor after cardiac death (DCD), represent a promising source of grafts. Nevertheless, the initial period of warm ischemia can compromise the graft viability. Modified preservation techniques are crucial in stopping or reversing cellular injury, through cytoprotective mechanisms, allowing the recovery of a great portion of these grafts. Selective normothermic extracorporeal membrane oxygenation (NECMO) minimizes ischemic injury, playing a protective role on organ function preservation and maintaining tissue perfusion under controlled condition and temperature to restore metabolic processes. NECMO is believed to shift warm ischemic time toward ischemic preconditioning, providing greater viability for DCD donors. In the clinical setting, NECMO has been demonstrated to offer the possibility to obtain good quality grafts for transplant both in controlled and in uncontrolled DCD. Furthermore, in some countries ECMO has been used to support brain death (BD) multiorgan donors in case in which it is not possible to complete death assessment for cardiac or respiratory failure.