Interhospital transfers of a mobile team for organ preservation with extracorporeal membrane oxygenation in controlled donors after circulatory death

Role of normothermic perfusion with ECMO in donation after controlled cardiac death in Spain

Spain has become one of the most active countries in donation after controlled cardiac death, using normothermic abdominal perfusion with ECMO in more than 50% of all donors - a situation contributed to by the creation of mobile teams to support hospitals lacking this technology. The donation process must be respectful of the wishes and values of the patients and their relatives, especially if there is pre mortem manipulation, and the absence of cerebral perfusion should be guaranteed. The liver is the most benefited organ by reducing biliary complications as well as the loss of grafts. In renal transplantation, the technique could contribute to reduce the incidence of delayed graft function. In addition, the procedure is compatible with surgical rapid recovery in hypothermia when there is also lung donation. The future lies in the consolidation of cardiac donation by extending normothermic perfusion to the thoracic cavity.

Extra-Corporeal Membrane Oxygenation Cadaver Donors: What about Tissues Used as Allografts?

Several studies demonstrated the efficacy of post-mortem extracorporeal membrane oxygenation (ECMO) on donors in preserving organ function addressing organ transplantation. Nevertheless, no common and shared evidence was reached about the possibility of using ECMO donors in tissue harvesting. Therefore, this work aimed first to review the current scientific literature about ECMO donors, and then to focus on the use of ECMO tissues as allografts, mainly addressing musculoskeletal tissues, which are of the most interest for reconstruction. A search was conducted on the current scientific literature, focusing on the keywords "ECMO" and "Donor". Several online databases were used, including PubMed, Scopus, and Web of Science. From the preliminary search, 478 articles were obtained, out of which 173 specifically reported the use of ECMO for donation and transplantation purposes. Literature reported extensive analyses of ECMO organs-overall from the abdomen-both in pre- and post-transplantation studies. On the other hand, ECMO tissues were explanted only in a very limited number of cases; moreover, no information was referred about their status and use. A revision of the current scientific literature highlighted the lack of information concerning ECMO tissues and the necessity to perform preclinical, ex vivo studies to compare allografts from ECMO donors, with respect to standard donors, and, thus, to verify whether they can be harvested and implanted safely and with efficacy.

Role of normothermic perfusión with ECMO in donation after controlled cardiac death in Spain

Spain has become one of the most active countries in donation after controlled cardiac death, using normothermic abdominal perfusion with ECMO in more than 50% of all donors - a situation contributed to by the creation of mobile teams to support hospitals lacking this technology. The donation process must be respectful of the wishes and values of the patients and their relatives, especially if there is pre mortem manipulation, and the absence of cerebral perfusion should be guaranteed. The liver is the most benefited organ by reducing biliary complications as well as the loss of grafts. In renal transplantation, the technique could contribute to reduce the incidence of delayed graft function. In addition, the procedure is compatible with surgical rapid recovery in hypothermia when there is also lung donation. The future lies in the consolidation of cardiac donation by extending normothermic perfusion to the thoracic cavity.

Mobile Extracorporeal Membrane Oxygenation Teams for Organ Donation After Circulatory Death

The shortage of available organ donors is a significant problem worldwide, and various efforts have been carried out to avoid the loss of potential organ donors. Among them, organ donation from cardiocirculatory deceased donors (DCD), in which withdrawal of life-sustaining therapies is ongoing (Maastricht type III donors), is one emerging strategy. Thanks to the latest advances in transplantation and organ preservation, such as normothermic regional perfusion (NRP), ex vivo perfusion techniques, and good organization and communication among prehospital care providers, emergency departments, intensive care units, and transplantation units, DCD is rapidly increasing; it's estimated that it will increase the number of donations of lungs and splanchnic organs by more than 40%. Although Maastricht type II DCD requires a 24/7 available experienced extra corporeal membrane oxygenation (ECMO) team in the institution, Maastricht DCD type III could be organized in secondary care and spoke hospitals without in loco ECMO facilities for NRP. This article analyses a potential mobile team organization based on the hub-and-spoke model, which already exists and functions in Italy, by estimating the dimension of the controlled DCD phenomenon in Italy, coordination requirements, costs, personnel training, and education, and reporting a single center experience in Milan, Italy.

Interhospital Transfers of a Mobile Extracorporeal Membrane Oxygenation Team for Maastricht III Donations

OBJECTIVE

The objective is to describe the donations made with extracorporeal membrane oxygenation as a method of preservation to meet the characteristics of the donors and the transplants obtained.

METHODS

This was a retrospective descriptive study, using the donation registration data made at Virgen de las Nieves Hospital from 2010 to February 2018.

RESULTS

A total of 11 transfers occurred: 2 to the province of Jaen (Jaen Hospital, 92 km from Virgen de las Nieves Hospital; San Agustín Hospital, Linares, 136 km), 1 to Santa Ana Hospital, Motril (68 km), 1 to Poniente Hospital, El Ejido, Almeria (137 km), and 7 trips within the city of Granada. From these donations, a total of 21 kidneys, 3 livers, 10 corneal transplants, 4 extractions of osteotendinous tissue, and 1 extraction of vascular tissue were obtained.

CONCLUSION

Extracorporeal membrane oxygenation mobile teams can enable donation in controlled donation after circulatory death with normothermic preservation in hospitals without these resources, which increases the donor group and optimizes graft results.