(361) Expanding the Harvest: Utilization of VV ECMO in Donation After Cardiac Death (DCD)

Introduction: Extracorporeal mechanical oxygenation (ECMO) has expanded worldwide, yet despite advances in cardiopulmonary support with ECMO, mortality remains high. ECMO patients are eligible for organ donation following withdrawal of life-sustaining measures or death by neurologic criteria though despite increases in organ donation, a supply and demand gap remain. Despite lack of consensus on organ donation from ECMO patients, it is an emerging mode to expand the organ pool. A single center study that implemented a DCD ECMO protocol expanded their donor pool by 33% (1).

Description: A 37-year-old male with diabetes and opioid use disorder presented to the emergency department with dyspnea, malaise, and productive cough. Initial workup revealed diabetic ketoacidosis and cavitary pneumonia. Blood cultures grew candida glabrata. He developed worsening respiratory failure requiring intubation, but remained hypoxic despite use of inhaled nitric oxide and was cannulated for VV-ECMO. His course was complicated by worsening septic shock requiring vasopressors, bronchopleural fistula formation managed with chest tube placement, and hemothorax requiring multiple transfusions. Bronchoscopy lavage was positive for herpes simplex virus 1 for which he was treated. Despite escalating antimicrobial therapy, he did not show recovery in respiratory status or septic shock signaling no possibility to survive without ECMO. His family expressed their wishes for comfort care and evaluation for organ donation, after which both kidneys and the liver were procured. The organs were successfully transplanted into three separate recipients.

Discussion: We present a case of successful organ procurement and transplant from a patient on VV-ECMO after cardiac death. This illustrates how ECMO can be utilized for the purpose of organ preservation as one third of patients referred for organ procurement are on ECMO (2). A recent systematic review reported a 98% survival rate of recipients within 3 year follow up and 92% preserved graft function of the organ transplanted (3). One report showed that the number of donor hearts available could increase by 30% with the use of DCD donors (4). While resource-intensive, ECMO can be considered and utilized to expand the donor pool as illustrated by this case.