Open AccessThe ethics of extracorporeal membrane oxygenation in brain‐dead potential organ donors
Author(s) -
Dalle Ave Anne L.,
Gardiner Dale,
Shaw David M.
Publication year - 2016
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.12772
Subject(s) - extracorporeal membrane oxygenation , medicine , brain dead , organ donation , life support , legislation , intensive care medicine , extracorporeal , donation , ethical issues , transplantation , medical emergency , surgery , law , engineering ethics , political science , engineering
Summary Organ‐preserving extracorporeal membrane oxygenation ( OP ‐ ECMO ) is defined as the use of extracorporeal support for the primary purpose of preserving organs for transplantation, rather than to save the patient's life. This paper discusses the ethics of using OP ‐ ECMO in donation after brain determination of death ( DBDD ) to avoid the loss of organs for transplantation. We review case reports in the literature and analyze the ethical issues raised. We conclude that there is little additional ethical concern in continuing OP ‐ ECMO in patients already on ECMO if they become brain dead. The implementation of OP ‐ ECMO in hemodynamically unstable brain‐dead patients is ethically permissible in certain clinical situations but requires specific consent from relatives if the patient's wish to donate is not clear. If no evidence of a patient's wish to donate is available, OP ‐ ECMO is not recommended. In countries with presumed consent legislation, failure to opt out should be considered as a positive wish to donate. If a patient is not‐yet brain‐dead or is undergoing testing for brain death, OP ‐ ECMO is not recommended. Further research on OP ‐ ECMO is needed to better understand the attitudes of professionals, families, and lay people to ensure agreement on key ethical issues.