Experience of Venoarterial Extracorporeal Life Support-Assisted Brain Death Donation With Severe Hemodynamic Instability.

Objective: To explore the experience of extracorporeal life support (ECLS)-assisted maintenance of brain death donors with extremely unstable hemodynamics.

Methods: We retrospectively analyzed the clinical data of 12 brain-dead donors who received ECLS in our hospital from May 2015 to May 2022 due to extremely unstable hemodynamics. The organ acquisition status was analyzed. The transplant outcome of the livers and kidneys procured from these donors on ECLS was also evaluated, who are currently considered as having extended criteria.

Results: After ECLS, the hemodynamics of these 12 patients quickly stabilized and all completed apnea testing and reached the criteria for brain death. The 12 donors on ECLS contributed 36 organs: 1 heart, 2 lungs, 11 livers, and 22 kidneys. All liver and kidney transplant recipients survived within 1 year after transplantation. The 12-month graft survival rate for these 22 ECLS transplanted kidneys was 95%. Four (18.2%) kidney transplant recipients developed DGF. The average creatinine at discharge was 2.01 ± 0.70 mg/dL (1.14-3.67 mg/dL), which showed a downward trend in the first year after operation. The 12-month graft survival rate for these 11 ECLS transplanted livers was 100%. There was no incidence of primary nonfunction. The transaminase and bilirubin in the liver transplantation recipient group showed a downward trend, with an average total bilirubin of 2.23 ± 0.17 mg/dL (1.93-2.46 mg/dL) and an average alanine aminotransferase level of 46.55 ± 17.45 (33-89 units/L) at the time of discharge.

Conclusions: ECLS can maintain the organ function of potential brain death donors with extremely unstable circulation and does not affect the functional recovery of the graft.