Organ donation after extracorporeal cardiopulmonary resuscitation: a nationwide retrospective cohort study

Abstract

Background: Limited data are available on organ donation practices and recipient outcomes, particularly when comparing donors who experienced cardiac arrest and received extracorporeal cardiopulmonary resuscitation (ECPR) followed by veno-arterial extracorporeal membrane oxygenation (ECMO) decannulation, versus those who experienced cardiac arrest without receiving ECPR. This study aims to explore organ donation practices and outcomes post-ECPR to enhance our understanding of the donation potential after cardiac arrest.

Methods: We conducted a nationwide retrospective cohort study using data from the Japan Organ Transplant Network database, covering all deceased organ donors between July 17, 2010, and August 31, 2022. We included donors who experienced at least one episode of cardiac arrest. During the study period, patients undergoing ECMO treatment were not eligible for a legal diagnosis of brain death. We compared the timeframes associated with each donor's management and the long-term graft outcomes of recipients between ECPR and non-ECPR groups.

Results: Among 370 brain death donors with an episode of cardiac arrest, 26 (7.0%) received ECPR and 344 (93.0%) did not; the majority were due to out-of-hospital cardiac arrests. The median duration of veno-arterial ECMO support after ECPR was 3 days. Patients in the ECPR group had significantly longer intervals from admission to organ procurement compared to those not receiving ECPR (13 vs. 9 days, P = 0.005). Lung graft survival rates were significantly lower in the ECPR group (log-rank test P = 0.009), with no significant differences in other organ graft survival rates. Of 160 circulatory death donors with an episode of cardiac arrest, 27 (16.9%) received ECPR and 133 (83.1%) did not. Time intervals from admission to organ procurement following circulatory death and graft survival showed no significant differences between ECPR and non-ECPR groups. The number of organs donated was similar between the ECPR and non-ECPR groups, regardless of brain or circulatory death.

Conclusions: This nationwide study reveals that lung graft survival was lower in recipients from ECPR-treated donors, highlighting the need for targeted research and protocol adjustments in post-ECPR organ donation.

Keywords: Brain death; Cardiopulmonary resuscitation; Extracorporeal membrane oxygenation; Organ transplantation; Out-of-hospital cardiac arrest; Tissue and organ procurement.

Fig. 1

The Kaplan–Meier curve of graft survival for each organ among recipients from brain-dead organ donors, comparing those who had received ECPR with those who had not. The P values obtained from the log-rank test for heart, lung, liver, pancreas, kidney, and small intestine were 0.072, 0.009, 0.950, 0.902, 0.577, and 0.519, respectively. The median observation periods for grafts from donors who experienced cardiac arrest and received ECPR versus those from non-ECPR donors, respectively, were as follows: for heart grafts, 1203 days (IQR: 542 to 2278) and 1690 days (IQR: 908 to 2610); for lung grafts, 777 days (IQR: 573 to 1816) and 1323 days (IQR: 596 to 2211); for liver grafts, 1816 days (IQR: 671 to 2438) and 1551 days (IQR: 738 to 2466); for pancreas grafts, 1083 days (IQR: 442 to 2118) and 1708 days (IQR: 677 to 2673); for kidney grafts from brain-dead donors, 1787 days (IQR: 736 to 2429) and 1690 days (IQR: 987 to 2576); and for small intestine grafts, 2446 days (IQR: 2446 to 2446) and 703 days (IQR: 404 to 1217); ECPR: extracorporeal cardiopulmonary resuscitation

Fig. 2

The Kaplan–Meier curve of graft survival for kidney among recipients from circulatory-dead organ donors, comparing those who had received ECPR with those who had not. The P values obtained from the log-rank test were 0.363. The median observation periods for grafts from donors who experienced cardiac arrest and received ECPR versus those from non-ECPR donors were 2071 days (IQR: 1004 to 3110) and 2160 days (IQR: 1175 to 3535), respectively. ECPR: extracorporeal cardiopulmonary resuscitation