The Extra Corporeal Membrane Oxygenation (ECMO) in the Deceased Donors after Brain Death with Severe Hemodynamic Instability Allow to Optimize the Viability of Organs Procured for Transplantation

Abstract

Introduction Some of the brain death donor manifest severe circulatory dysfunction that can lead to cardiac arrest and subsequently to donor lose or low quality of organs procured. Extra-corporeal membrane oxygenation (ECMO) can be applied to these donors to obtain organs with better quality with less ischemic damage. Objective To observe the clinical effect of the maintenance for the organ function by ECMO in brain death donor with severe hemodynamic instability. Methods 89 brain death donors maintained by ECMO were follow-up. The criteria for using the ECMO to protect the organ function were: A.Cardiac arrest, cardiopulmonary resuscitation history (cardiac compression>20min); B.Mean arterial pressure (MAP): in Adults<60~70mmHg; in children<50~60mmHg; in infant<40~50mmHg; C.Cardiac index<2L/m2·min)(3h);D.Large doses of vasoactive drugs: dopamine>20μg/(kg·min); (norepinephrine) epinephrine >1.0μg/(kg • min) (3h); E.Oliguria: <0.5mL/(kg·h); F.Blood biochemical indexes: Moderate, severe impairment on acute hepatic and renal function; G.Others: ST-T significantly changes in electrocardiogram; difficulty to correct the metabolic acidosis (3h). The organs were evaluated during their retrieval and as well their evolution after transplantation was evaluated. Results a total of 89 cases with ECMO maintenance were collected, equal to100 % of the total donation cases (100%). 178 kidneys, 89 livers were procured from these donors meanwhile 13 kidneys and 38 livers were discarded. Out of the discarded organs, 8 and 25 kidneys and livers respectively, were discarded due to ischemic damage as it was shown in a macroscopic evaluation. 165 of the procured kidneys were transplanted. DGF of kidney transplantation was observed in 18.8 % of the cases. Acute rejection incidence was 12.1%. Kidney survival rate was: 99.3% in one year,97.8% in three year,and 97.8% in five year. There was no difference outcome in patient or graft survival between the group with ECMO and the group without ECMO. Conclusion Our experience indicates that ECMO allows for the maintenance of abdominal organ tissue perfusion without warm ischemia before organ procurement, providing sufficient time for safe organ donation procedures and reducing the risk of unpredictable cardiac arrest that could result in the donor death and graft loss.ECMO in the brain dead donors with severe circulatory dysfunction allows to avoid organ donors lose and obtain good quality kidneys and livers; meaning low rates of primary dysfunction, DGF and acute rejection with excellent graft survival after transplantation.