Introduction:
In refractory cardiac arrest, extracorporeal cardiopulmonary resuscitation (ECPR) may increase the chance of survival. However, in brain death or donation after cardiac death scenario, ECPR may also become an important organ donor source.
Hypothesis:
We hypothesized that 1/ the implementation of ECPR into the daily routine of a high volume cardiac arrest centre might increase the availability of organ donors, and 2/ ECPR might assure the same long-term function of donated organs as non-ECPR care.
Methods:
We retrospectively evaluated pre-ECPR (2007-2011) and ECPR (2012-2020) periods in terms of donors recruited from the out-of-hospital and in-hospital cardiac arrest population. We assessed the number of donors referred, the number of organs harvested and their one- and five-year survival.
Results:
In the pre-ECPR period, 11 donors were referred, of which 7 were accepted. During the ECPR period, the number of donors increased to 80, of which 42 were accepted. The number of donated organs in respective periods were 18 and 119, corresponding to 3,6 vs 13,2 (p =0.033) organs per year harvested. One-year survival of transplanted organs was 94.4% vs 100%, and five-year survival was 94.4% vs 87,5%, in relevant periods. Survival of organs obtained from donors after CPR and ECPR at one year (98.9% vs 100%) and five years (90,2% vs 88.9%) was the same. Graft failure was not the cause of death in any single case.
Conclusions:
Establishing a high volume cardiac arrest/ECPR centre may lead to a higher number of potential and subsequently accepted organ donors. The length of survival of donated organs is high and comparable between ECPR vs non-ECPR cardiac arrest donors.
Optimisation of the organ donor and effects on transplanted organs: a narrative review on current practice and future directions