Lung Transplantation From Donation After Brain Death Donors on Extracorporeal Support

Shortage of lung donors has led transplantation programs to work on new approaches to getting potential donors. In contrast, lung transplant surgeons face the advances in treatments for critically ill patients, including the increased use of extracorporeal membrane oxygenation (ECMO) support. The use of donors on ECMO raises some concerns: endothelial injury and pulmonary edema because of extracorporeal circulation-induced systemic inflammatory response syndrome; pulmonary congestion, caused by increased left ventricle afterload (venoarterial ECMO); alveolar hemorrhage induced by pulmonary edema; and anticoagulation therapies. Also, the criteria for determination of death and the assessment of graft quality are challenging in potential donors on ECMO. We report the experience of lung recipients from donors after neurological determination of death (DBD) while on ECMO support from 3 centers of the European Society of Thoracic Surgeons Lung Transplantation Working Group