Organ Donor Potential After Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest: A Post-Hoc Analysis of a Randomized Controlled Trial

Hanne C R Verberght^{1

2}, Thijs S R Delnoij^{3

4}, Martje M Suverein³, Jody Lunsing³, Renicus C Hermanides⁵, Luuk Otterspoor⁶, Carlos V Elzo Kraemer⁷, Alexander P J Vlaar⁸, Joris J van der Heijden⁹, Erik Scholten¹⁰, Corstiaan A den Uil¹¹, Dinis Dos Reis Miranda¹², Sakir Akin¹³, Jesse de Metz¹⁴, Iwan C C van der Horst^{3

15

16}, Bas J Mathot¹⁷, Jeroen de Jonge¹⁸, Mijntje W N Nijboer¹⁹, Vincent E de Meijer²⁰, Jan S F Sanders²¹, Maarten H L Christiaans²², Arjan D van Zuilen²³, Hanneke Hagenaars²⁴, Jentina Wind²⁵, Miranda Danhof²⁶, Steven W M Olde Damink^{1

2

27}, Bjorn Winkens^{28

29}, Jos G Maessen³⁰, Roberto Lorusso^{15

30}, Marcel C G van de Poll^{1

2

3}; INCEPTION‐investigators

Affiliations

¹ Department of Surgery, Maastricht University Medical Center+, Maastricht University, Maastricht, the Netherlands.
² Institute For Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands.
³ Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht University, Maastricht, the Netherlands.
⁴ Department of Cardiology, Maastricht University Medical Center+, Maastricht University, Maastricht, the Netherlands.
⁵ Department of Cardiology, Isala Clinics, Zwolle, the Netherlands.
⁶ Department of Intensive Care, Catharina Hospital, Eindhoven, the Netherlands.
⁷ Department of Intensive Care, Leiden University Medical Center, Leiden University, Leiden, the Netherlands.
⁸ Department of Intensive Care, Amsterdam University Medical Center location AMC, University, Amsterdam, Amsterdam, the Netherlands.
⁹ Department of Intensive Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
¹⁰ Department of Intensive Care, St. Antonius Hospital, Nieuwegein, the Netherlands.
¹¹ Department of Intensive Care Medicine, Maasstad Hospital, Rotterdam, the Netherlands.
¹² Department of Intensive Care, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands.
¹³ Department of Intensive Care, Haga Hospital, The Hague, the Netherlands.
¹⁴ Department of Intensive Care, OLVG, Amsterdam, the Netherlands.
¹⁵ Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands.
¹⁶ Albert Schweitzer Hospital, Dordrecht, the Netherlands.
¹⁷ Department of Pulmonary Medicine, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands.
¹⁸ Department of Surgery, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands.
¹⁹ Department of Surgery, Leiden University Medical Center, Leiden University, Leiden, the Netherlands.
²⁰ Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
²¹ Department of Nephrology, University Medical Center Groningen, Groningen, the Netherlands.
²² Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, Maastricht University, Maastricht, the Netherlands.
²³ Department of Nephrology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
²⁴ Organ Donation Coordinator, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands.
²⁵ Organ Donation Coordinator, Maastricht University Medical Centre, Maastricht, the Netherlands.
²⁶ Organ Donation Coordinator, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
²⁷ Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Essen, Essen, Germany.
²⁸ Department of Methodology & Statistics, Maastricht University, Maastricht, the Netherlands.
²⁹ Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
³⁰ Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht University, Maastricht, the Netherlands.

PMID: 41243868
PMCID: PMC12621156
DOI: 10.1111/ctr.70382

Randomized Controlled Trial

Organ Donor Potential After Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest: A Post-Hoc Analysis of a Randomized Controlled Trial

Hanne C R Verberght et al. Clin Transplant. 2025 Nov.

. 2025 Nov;39(11):e70382.

doi: 10.1111/ctr.70382.

Authors

Affiliations

¹ Department of Surgery, Maastricht University Medical Center+, Maastricht University, Maastricht, the Netherlands.
² Institute For Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands.
³ Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht University, Maastricht, the Netherlands.
⁴ Department of Cardiology, Maastricht University Medical Center+, Maastricht University, Maastricht, the Netherlands.
⁵ Department of Cardiology, Isala Clinics, Zwolle, the Netherlands.
⁶ Department of Intensive Care, Catharina Hospital, Eindhoven, the Netherlands.
⁷ Department of Intensive Care, Leiden University Medical Center, Leiden University, Leiden, the Netherlands.
⁸ Department of Intensive Care, Amsterdam University Medical Center location AMC, University, Amsterdam, Amsterdam, the Netherlands.
⁹ Department of Intensive Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
¹⁰ Department of Intensive Care, St. Antonius Hospital, Nieuwegein, the Netherlands.
¹¹ Department of Intensive Care Medicine, Maasstad Hospital, Rotterdam, the Netherlands.
¹² Department of Intensive Care, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands.
¹³ Department of Intensive Care, Haga Hospital, The Hague, the Netherlands.
¹⁴ Department of Intensive Care, OLVG, Amsterdam, the Netherlands.
¹⁵ Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands.
¹⁶ Albert Schweitzer Hospital, Dordrecht, the Netherlands.
¹⁷ Department of Pulmonary Medicine, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands.
¹⁸ Department of Surgery, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands.
¹⁹ Department of Surgery, Leiden University Medical Center, Leiden University, Leiden, the Netherlands.
²⁰ Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
²¹ Department of Nephrology, University Medical Center Groningen, Groningen, the Netherlands.
²² Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, Maastricht University, Maastricht, the Netherlands.
²³ Department of Nephrology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
²⁴ Organ Donation Coordinator, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands.
²⁵ Organ Donation Coordinator, Maastricht University Medical Centre, Maastricht, the Netherlands.
²⁶ Organ Donation Coordinator, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
²⁷ Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Essen, Essen, Germany.
²⁸ Department of Methodology & Statistics, Maastricht University, Maastricht, the Netherlands.
²⁹ Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
³⁰ Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht University, Maastricht, the Netherlands.

PMID: 41243868
PMCID: PMC12621156
DOI: 10.1111/ctr.70382

Abstract

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) is a potentially life-saving intervention in refractory out-of-hospital cardiac arrest (OHCA). ECPR enables, in most of the treated cases, ICU admission to patients who otherwise would have died at the emergency department (ED). Still, many of them die, frequently after withdrawal of life-sustaining therapies due to irreversible critical conditions and related complications. The additional time provided by ECPR, however, might allow for the assessment of organ donor suitability. The aim of this study was to evaluate the impact of ECPR on the number of potential organ donors after refractory OHCA.

Methods: We performed a post-hoc analysis of the multicenter INCEPTION trial, which randomized 134 OHCA patients between conventional CPR (CCPR) and ECPR. Detailed patient reports were presented to transplant physicians to determine the acceptability of the liver and kidneys for organ donation. In addition to the intention to treat analysis, we performed an "as-treated" analysis, limited to patients arriving without return of spontaneous circulation (ROSC) at the ED.

Results: Out of 70 patients randomized to ECPR and 64 to CCPR, potential organ donors were identified in 14 (20%) and 4 (6%) patients, respectively (χ² test, p = 0.038). In the as-treated analysis, 15 out of 55 (27%) treated with ECPR were potential donors, compared to 0 out of 59 treated with CCPR (p < 0.001). This included five (9%) potential kidney donors and 15 (27%) potential liver donors.

Conclusion: Although ECPR is currently used with life-saving intentions, it may simultaneously increase the number of potential organ donors following cardiac arrest in selected patients.

Trial registration: ClinicalTrials.gov identifier: NCT03101787.

Keywords: extracorporeal cardiopulmonary resuscitation; organ donation; out‐of‐hospital cardiac arrest.

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Conflict of interest statement

The authors declare no conflicts of interest. Except for Roberto Lorusso he is a consultant at ABIOMED and gets a lecture fee and a consultant at Xenios where he is in the medical advisory board. Dinis dos Reis Miranda has a speaking engagement to MAQUET Cardiovascular L.L.C.

References

1. HV C. F., Chastel O., Sutter P., et al. Thematic Network on Improving Organ Donation and Transplantation in the EU—Joint Statement. European kidney health alliance. 2019.
1. Kootstra G., Daemen J. H., and Oomen A. P., “Categories of Non‐Heart‐Beating Donors,” Transplantation Proceedings 27, no. 5 (1995): 2893–2894. - PubMed
1. Lomero M., Gardiner D., Coll E., et al., “Donation After Circulatory Death Today: An Updated Overview of the European Landscape,” Transplant International 33, no. 1 (2020): 76–88. - PubMed
1. Suverein M. M., Maessen J. G., and van de Poll M. C. G., “Extracorporeal Cardiopulmonary Resuscitation in Out‐of‐Hospital Cardiac Arrest—Current Status,” Current Opinion in Critical Care 29, no. 6 (2023): 633–639. - PMC - PubMed
1. Carlson J. M., Etchill E., Whitman G., et al., “Early Withdrawal of Life Sustaining Therapy in Extracorporeal Cardiopulmonary Resuscitation (ECPR): Results From the Extracorporeal Life Support Organization Registry,” Resuscitation 179 (2022): 71–77. - PMC - PubMed

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Organ Donor Potential After Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest: A Post-Hoc Analysis of a Randomized Controlled Trial

Affiliations

Organ Donor Potential After Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest: A Post-Hoc Analysis of a Randomized Controlled Trial

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Associated data

LinkOut - more resources

Full Text Sources

Medical