Solid organ donation in a child after extracorporeal membrane oxygenation, orthotopic heart transplantation, and ventricular assist device support

Brain-Dead Donors on Extracorporeal Membrane Oxygenation

OBJECTIVES

To describe donors after brain death with ongoing extracorporeal membrane oxygenation and to analyze the outcome of organs transplanted from these donors.

DESIGN

Retrospective analysis of the national information system run by the French Biomedicine Agency (CRISTAL database).

SETTING

National registry data of all donors after brain death in France and their organ recipients between 2007 and 2013.

PATIENTS

Donors after brain death and their organ recipients.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

During the study period, there were 22,270 brain-dead patients diagnosed in France, of whom 161 with extracorporeal membrane oxygenation. Among these patients, 64 donors on extracorporeal membrane oxygenation and 10,805 donors without extracorporeal membrane oxygenation had at least one organ retrieved. Donors on extracorporeal membrane oxygenation were significantly younger and had more severe intensive care medical conditions (hemodynamic, biological, renal, and liver insults) than donors without extracorporeal membrane oxygenation. One hundred nine kidneys, 37 livers, seven hearts, and one lung were successfully transplanted from donors on extracorporeal membrane oxygenation. We found no significant difference in 1-year kidney graft survival (p = 0.24) and function between recipients from donors on extracorporeal membrane oxygenation (92.7% [85.9-96.3%]) and matching recipients from donors without extracorporeal membrane oxygenation (95.4% [93.0-97.0%]). We also found no significant difference in 1-year liver recipient survival (p = 0.91): 86.5% (70.5-94.1) from donors on extracorporeal membrane oxygenation versus 80.7% (79.8-81.6) from donors without extracorporeal membrane oxygenation.

CONCLUSIONS

Brain-dead patients with ongoing extracorporeal membrane oxygenation have more severe medical conditions than those without extracorporeal membrane oxygenation. However, kidney graft survival and function were no different than usual. Brain-dead patients with ongoing extracorporeal membrane oxygenation are suitable for organ procurement.

Using ultrasonography to monitor liver blood flow for liver transplant from donors supported on extracorporeal membrane oxygenation

Extracorporeal membrane oxygenation (ECMO) has been used to support brain-dead donors for liver procurement. This study investigated the potential role of ultrasonographic monitoring of hepatic perfusion as an aid to improve the viability of liver transplants obtained from brain-dead donors who are supported on ECMO. A total of 40 brain-dead patients maintained on ECMO served as the study population. Hepatic blood flow was monitored using ultrasonography, and perioperative optimal perfusion was maintained by calibrating ECMO. Liver function tests were performed to assess the viability of the graft. The hepatic arterial blood flow was well maintained with no significant changes observed before and after ECMO (206 ± 32 versus 241 ± 45 mL/minute; P = 0.06). Similarly, the portal venous blood flow was also maintained throughout (451 ± 65 versus 482 ± 77 mL/minute; P = 0.09). No significant change in levels of total bilirubin, alanine transaminase, and lactic acid were reported during ECMO (P = 0.17, P = 0.08, and P = 0.09, respectively). Before the liver is procured, ultrasonographic monitoring of hepatic blood flow could be a valuable aid to improve the viability of a liver transplant by allowing for real-time calibration of ECMO perfusion in brain-dead liver donors. In our study, ultrasonographic monitoring helped prevent warm ischemic injury to the liver graft by avoiding both overperfusion and underperfusion of the liver.

STRUCTURAL DESIGN AND NUMERICAL SIMULATION OF THE DIFFUSER FOR MAGLEV AXIAL BLOOD PUMP

Hydraulic performance is an especially important factor for maglev axial blood pumps that have been used in patients with heart disease. Most maglev axial blood pumps basically consist of a straightener, an impeller and a diffuser. The diffuser plays a key role in the performance of the maglev axial blood pump to provide an adequate pressure head and increase the hydraulic efficiency. Maglev axial blood pumps with various structural diffusers exhibit different hydraulic performance. In this study, computational fluid dynamics (CFD) analysis was performed to quantify hydrodynamic in a maglev axial blood pump with a flow rate of 6 L/min against a pressure head of 100 mmHg to optimize the diffuser structure. First, we design the prototype of diffuser structure based on traditional design method, establish blood flow channel models using commercial software ANSYS FLUENT. Specifically, compare the performance of pump with the diffusers of different parameters, such as the leading edge blade angle, blade-thickness and blade-number. The results show that the diffuser structures with the thickening blade by arc airfoil law, blade-number of 6, leading edge blade angle of 24°, and trailing edge blade angle of 90° exhibited the best hydraulic performance which could be utilized in the optimization design of maglev axial blood pumps.