Declaring a Patient Brain Dead on Extracorporeal Membrane Oxygenation (ECMO): Are There Guidelines or Misconceptions?
1Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
2Gift of Life Donor Program, Philadelphia, PA
3Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA.
Meeting: 2015 American Transplant Congress
Abstract number: A224
Keywords: Brain death, Donation, Kidney/liver transplantation
Session Information
Session Name: Poster Session A: Non Organ Specific, Economics, Public Policy, Allocation, Ethics
Session Type: Poster Session
Date: Saturday, May 2, 2015
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Exhibit Hall E
Purpose: With the rapid growth of ECMO and the accumulating evidence that organs from ECMO donors can be safely transplanted, we reviewed the practice variations and trends involved with declaring patients brain dead on ECMO.
Methods: After institutional review board approval, a retrospective chart review from our local organ procurement organization was performed to identify patients declared brain dead on ECMO who became organ donors. Between 1995 and 2014, 26 patients were identified [13 male, median age 19 (4 months-67 years)]. Demographics, causes of death, and clinical and ancillary studies used to pronounce brain death were recorded from charts.
Results: All patients underwent one to two clinical exams as the first step in the declaration of brain death. In addition to clinical exam, 15 (58%) of the patients underwent apnea testing, and of those patients, seven (48%) also had at least one ancillary test performed. Apnea testing was not utilized in 11 (42%) of the patients, and of those, nine (82%) had one or more ancillary tests performed to confirm brain death. Two (18%) patients only underwent clinical exam to declare brain death. Eighty-three percent of patient from 1995 to 2008 underwent apnea testing compared with only 50% of patients from 2008 to 2014. The majority of patients (82%) for which apnea testing was not used were patients after 2008. All cases in which ECMO was documented as the reason for not doing an apnea test occurred after 2008. Multiple ancillary tests were used in the diagnosis of brain death. The most common ancillary test used from 1995 through 2009 was electroencephalography, whereas the most common test from 2010 to 2014 was the cerebral blood flow study.
Conclusions: This study shows that the diagnosis of brain death on ECMO lacks consensus guidelines regarding clinical exam, performance of apnea testing and use of definitive ancillary testing. The difficulty and controversy with performing a standard apnea test while on ECMO has led to inconsistent performance of and interpretation of the test, which has prompted unguided use of ancillary studies. Due to the substantial increase in the use of ECMO, it is vital that guidelines are developed to guide clinicians in the accurate diagnosis of brain death in patients on ECMO.
To cite this abstract in AMA style:
Kreitler K, Cavarocchi N, Hirose H, West S, Hasz R, Ghobrial M, Bell R. Declaring a Patient Brain Dead on Extracorporeal Membrane Oxygenation (ECMO): Are There Guidelines or Misconceptions? [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/declaring-a-patient-brain-dead-on-extracorporeal-membrane-oxygenation-ecmo-are-there-guidelines-or-misconceptions/. Accessed May 19, 2025.« Back to 2015 American Transplant Congress