title: The use of extracorporeal membranous oxygenation in donors after cardiac death.
abstract: OBJECTIVE
  The purpose of the present review is to describe the methods using an extracorporeal membranous oxygenation (ECMO) circuit in donors after cardiac death and to evaluate their impact on the outcome of renal transplantation.
  
  
  RESULTS
  ECMO can be used either in hypothermic conditions for total body cooling or in normothermic conditions and limited to the abdomen in a first phase, before subsequent in-situ cooling. In both cases, oxygen is added to the perfusion, as compared with the usual and simple cold in-situ perfusion. There is a strong experimental rationale to use ECMO in normothermic conditions. The clinical studies in renal transplantation are still few, retrospective with small cohorts (level 3 or 4, according to the Oxford Centre for Evidence-Based Medicine). However, they all reach consistent conclusions with better kidney transplant outcome, both in uncontrolled (type I and II) and controlled (type III) donors, according to the Maastricht classification.
  
  
  CONCLUSIONS
  The use of ECMO in donors after cardio-circulatory death should be encouraged and further developed. Experimental work is in progress to better define the optimal conditions of the technique, which will help to limit or even repair the injuries, induced by warm ischaemia.
authors: Department of Urology, Nephrology and Transplantation, Groupe Hospitalier Pitié-Salpêtrière, Paris, France. benoit.barrou@psl.aphp.fr
authors: Benoit
authors: B
authors: Barrou
authors: Claire
authors: C
authors: Billault
authors: Armelle
authors: A
authors: Nicolas-Robin
mesh_terms: D003643:Death; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006323:Heart Arrest; D006801:Humans; D007668:Kidney / Q000502:physiology; D016030:Kidney Transplantation / Q000379:methods; D009926:Organ Preservation; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting; D009927:Tissue and Organ Procurement