Introduction: ECMO has become rescue therapy for adults with overwhelming cardiac and/or respiratory failure. Despite improving outcomes, not all patients are saved, creating a new cohort of potential organ donors. This study evaluates the outcomes and function of liver and kidney allografts procured from donors on ECMO.
Methods: An IRB approved, retrospective review of organ donors was conducted through the local organ procurement organization. Donors on ECMO support prior to organ recovery were classified into donation after brain death (DBD) and donation after cardiac death (DCD). We compared short-term outcome data against published standards.
Results: Between 1995 and 2012, 97 organs were procured from 41 donors (29 male / 12 female, a mean age of 40 years) supported on ECMO. The most common mechanism of death was cerebral ischemia with 29 DBD and 12 DCD. There were 68 kidneys donated, 51 were transplanted and 17 discarded. Excluding extended criteria donors, 29 DBD and 13 DCD kidneys were transplanted from donors supported on ECMO: DGF occurred in 34% of DBD kidneys and 38% of DCD kidneys. Median creatinine levels at discharge, 6 and 12 months were: 4.65 (± 2.8) md/gl, 1.43 (± 0.92) mg/dl and 1.5 (± 1.0) mg/dl, respectively. Kidney allograft survival at one year was 94%. Twenty-four livers were procured, 9 discarded and 15 transplanted (4 ECD, 14 DBD, 1 DCD). 92% of liver transplant recipients were alive with graft function at six months. Median total bilirubin levels at discharge, 6 months and 1 year were: 2.05 (± 3.36) mg/dl, 0.55 (± 0.38) mg/dl and 0.35 (± 0.41) mg/dl, respectively (Table 1).
Discussion: DBD kidneys procured from donors on ECMO perform similarly to non-ECMO organs with regard to DGF, one-year graft survival and function. Livers from ECMO donors have a higher discard rate than non-ECMO donors but function similarly at 6 months and one year. Given these data, ECMO donors should be utilized to increase the donor pool, understanding that kidney graft function may resemble DCD kidneys despite DBD status.
|Median (SD)||Discharge||6 month||12 month|
|Kidney||Creatinine mg/dl||4.65 (2.8)||1.43 (0.92)||1.5 (1.0)|
|Liver||Total Bilirubin mg/dl||2.05 (3.36)||0.55 (0.38)||0.35 (0.41)|
|AST units/L||48 (47)||43 (43)||24 (41)|
To cite this abstract in AMA style:Carter T, Bodzin A, Hirose H, Ochoa J, West S, Hasz R, Maley W, Cavarocchi N. Feasibility of Organ Donation on ECMO: An Analysis of Kidney and Liver Allograft Data [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/feasibility-of-organ-donation-on-ecmo-an-analysis-of-kidney-and-liver-allograft-data/. Accessed October 29, 2020.
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