Normothermic Regional Perfusion using ECMO technique increase the number of grafts recovered

Donating organs after cardiac arrest accounts for about 30% of organ donations in most countries. However, ischemic injury, which characterizes cardiac arrest and poor perfusion of organs during this period leads to the loss of many organs from this type of donors.Although the evidence remains limited, it appears that regional normothermic perfusion using ECMO devices can increase the number of grafts recovered and improve the outcome of receptors. Thus, countries like USA, UK and Spain are generalizing the use of these devices obtaining better results compared to the conventional extraction of organs by means of super fast extraction of the organs. In fact, the results obtained at the Marques de Valdecilla Hospital have shown a much higher survival rate than the international registries in renal, hepatic, pancreatic and pulmonary transplantation. However, the theoretical possibility of perfusing the brain of a deceased patient after the death declaration has limited the widespread acceptance of ECMO devices in asystole donation. In fact, some authors have expressed concern about the theoretical risk of brain reperfusion of a donor after the death declaration. Surprisingly, no proposal has been made to minimize this possibility that has raised concerns and bioethical conflicts.

The transplant group recently published a specific methodology to avoid this theoretical complication, being the first time a proposal is made to avoid this risk. In the present study, the HUMV proposal was validated in a multicenter study with 78 donors from Puerta de Hierro (Madrid), Clínica San Carlos (Madrid), Virgen de las Nieves (Granada) and HUMV. The methodology has been validated, guaranteed in all cases the absence of this theoretical complication derived from the ECMO devices.

Reference: Miñambres E, Suberviola B, Dominguez-Gil B, Rodrigo E, Ruiz-San Millan JC, Rodríguez-San Juan JC, Ballesteros MA. Improving the outcomes of organs obtained from controlled donation after circulatory death donors using abdominal normothermic regional perfusion. Am J Transplant. 2017 Jan 31. doi:10.1111/ajt.14214.