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Case Reports
. 2025 Feb;29(1):e70013.
doi: 10.1111/petr.70013.

Donation After Circulatory Determination of Death in Pediatric Patients on Extracorporeal Membrane Oxygenation at the Time of Death

Marwa Mansour  1 , Regina Okhuysen-Cawley  1   2 , Katherine Doane  1 , Lauren Jacobs  1 , Ryan Coleman  1 , Fong Wilson Lam  1 , Andrea Ontaneda  1
Affiliations
Case Reports

Donation After Circulatory Determination of Death in Pediatric Patients on Extracorporeal Membrane Oxygenation at the Time of Death

Marwa Mansour et al. Pediatr Transplant. 2025 Feb.

Abstract

Background: Pediatric solid organ transplantation is challenging due to the limited availability of suitable organs resulting in an increasing waitlist. Many pediatric transplant recipients receive organs from deceased donors, often after neurologic determination of death. Organ donation from patients on extracorporeal membrane oxygenation (ECMO) at the time of death has been described in adults, offering the potential for donation after circulatory determination of death (DCDD) with minimal ischemia time.

Case description: DCDD on ECMO requires a coordinated and seamless approach from a multidisciplinary team for clinical care. In this article, we aim to describe our institutional DCDD practice guidelines, which involve withdrawing ECMO support in the pediatric intensive care unit (PICU) or the operating room (OR), followed by organ procurement after the declaration of death, and our experience with DCDD in 2 pediatric patients on ECMO. In case 1, withdrawal of life-sustaining therapies (WOLST) occurred in the PICU with transport to the OR for DCDD. In case 2, both WOLST and DCDD occurred in the OR. In the described context, ECMO provided hemodynamic stability with minimal warm ischemia time for the donated organs.

Conclusions: This approach offers a novel resource for pediatric organ transplantation, potentially expanding the pediatric donor pool.

Keywords: DCDD; ECMO; organ donation; organ procurement; transplant.

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References

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