title: Ethical Issues in the Use of Extracorporeal Membrane Oxygenation in Controlled Donation After Circulatory Determination of Death.
abstract: The use of donor extracorporeal membrane oxygenation (ECMO) to improve graft outcomes by some controlled donation after circulatory determination of death (cDCDD) programs raises ethical issues. We reviewed cDCDD protocols using ECMO and the relevant ethics literature to analyze these issues. It is not obvious that ECMO in cDCDD improves graft outcomes. In our opinion, ECMO implemented before death can interfere with end-of-life care and damage bodily integrity. By restoring systemic circulation, ECMO risks invalidating the preceding declaration of death if brain and cardiac perfusion is not adequately excluded because of malfunction or misplacement of the supradiaphragmatic aortic occlusion balloon. The use of ECMO is not compatible with the acronym DCDD because circulation is restored after the determination of death. Because of these deficiencies, we concluded that other techniques are preferable, such as rapid recovery or in situ cold infusion. If ECMO is performed, it requires a specific informed consent and transparency.
authors.affiliation: Ethics Unit, University hospital of Lausanne, Lausanne, Switzerland.|Institute for Biomedical Ethics, University Medical Center, Geneva, Switzerland.
authors.forename: A L
authors.initials: AL
authors.lastname: Dalle Ave
authors.affiliation: Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.
authors.forename: D M
authors.initials: DM
authors.lastname: Shaw
authors.affiliation: Neurology Department, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: J L
authors.initials: JL
authors.lastname: Bernat
mesh_terms: D001926:Brain Death; D015199:Extracorporeal Membrane Oxygenation / Q000941:ethics*; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007258:Informed Consent; D009926:Organ Preservation; D016377:Organ Transplantation; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000379:methods*
keywords: artificial organs/support devices; donors and donation: donation after circulatory death (DCD); ethics and public policy; organ transplantation in general