Extracorporeal membrane oxygenation in donor preservation and organ procurement of donation after citizens' death / 中华器官移植杂志

ABSTRACT

Objective To study the effect of extracorporeal membrane oxygenation (ECMO) in donor preservation and organ procurement of donation after citizens' death.Method From 2013 to 2014,according to the ECMO indications,we used ECMO to provide circulation and breathing support for circulatory or respiratory function failure donation after brain death (DBD) donor and uncontrolled donation after cardiac death(DCD) donors.Through percutaneous liver puncture and living tissue rapid frozen section,the liver steatosis and fibrosis degree was determined.ECMO indications,ECMO related parameters and the result of blood gas analysis were recorded.alanine aminotransferase(ALT),aspartate aminotransferase(AST) and creatinine(Cr) before and after ECMO intervention were detected to evaluate liver and kidney function and damage.Whether the liver and kidney reached the requirements of the organ transplantation was assessed.Result The ECMO was used in 6 donors.Five cases of DBD were assisted through V-A ECMO because of circulatory or respiratory function failure.In one case of uncontrolled DCD recirculation was established through the thoracic aorta-blocked V-A ECMO.Four livers and 8 kidneys,from 4 donors,were retrieved and transplanted.Two donors' organs were discarded for damage beyond the standard.Conclusion For DBD donor with circulatory or respiratory function failure and uncontrolled DCD donors,the use of ECMO to assist circulatory and respiratory function or establish DCD recirculation can avoid liver and kidney injuries from vascular active drugs and DCD warm ischemia injury,thus,reduce the organ discarding rate of donation after citizens' death.