2001 OPEN FORUM Abstracts
SuccessfulMulti-Organ Donation on ECMO Support
Douglas R. Hansell BS, RRT, JohnJ.McCloskey MD, Thomas Pranikoff MD, Michael H. Hines MD FACS
INTRODUCTION:There are currently over 73,000 patients with life-threatening illnesses awaitingkidney, liver, pancreas, intestine, lung and heart transplantation in the UnitedStates, while less than 22,000 transplants were performed in1999. On average13 people die each day while waiting for an organ, and a new patient is addedto the list every 16 minutes. The main reason for this discrepancy is the severeshortage of donors. While efforts to increase donation as well as increase organsupply through xenograft research are underway, these will take time. Occasionally,patients supported on ECMO progress to brain death, despite excellent non-neurologicorgan function and may be and the results of the donation.
Methods: A 55year-old white female presented to an outside institution with presumed pneumoniaand worsening ARDS. She was transferred to our institution where she failedmaximal support including antibiotics, inotropic support, high PEEP and ventilationwith sedation and paralysis, and nitric oxide. She was placed on VV ECMO andthe sedation and paralysis were discontinued. After failing to demonstrate anyneurologic function once the medication had cleared, a CT scan was obtaineddemonstrating uncal herniation. A cerebral blood flow was obtained and demonstratedno flow. She was referred for organ donation after permission from the medicalexaminer. The family consented.
A 13 year-old whitefemale experienced chest pain and collapsed while skating. CPR was initiatedat the scene and she was resuscitated at the local hospital. Large doses ofvasopressors were required to support her blood pressure. An echocardiogramwas obtained and demonstrated very poor function possibly consistent with adilated cardiomyopathy. She was transferred to our institution for bridge totransplantation where she was placed on VA ECMO through the right neck. Herhemodynamics improved and her acidosis resolved, however, by 24 hours she demonstratedno neurologic function. A cerebral blood flow study was obtained and after demonstratingno flow, she was declared brain dead. After consulting with the medical examiner,the family was approached and consented to organ donation.
Results: Afterappropriate declaration and consent, both patients were maintained on ECMO,stabilized, and transported to the operating room for multiorgan harvest. Theliver from the first donor as well as the liver, pancreas and two kidneys fromthe second donor were all transplanted successfully. All recipients were reportedas doing well. While neither donor had usable lungs, the heart and kidneys fromthe first donor could not be placed in time, partly because of refusals dueto misinformation and a poor understanding of ECMO support.
CONCLUSION:Organ donation on ECMO is not only feasible but can be very successful fromdonors with isolated cardiopulmonary failure who are not septic and who haveno other organ dysfunction while supported on ECMO. Continued education is neededto make the most of potential organ donation from these patients.