Donación en asistolia controlada con el uso de perfusión regional normotérmica en membrana de circulación extracorpórea: experiencia en Colombia

Abstract

Introduction

Controlled donation after circulatory death (cDCD) is a strategy for the procurement and preservation of organs in patients with catastrophic and irreversible conditions that do not progress to brain death. Normothermic regional perfusion (NRP) using ExtraCorporeal Membrane Oxygenation (ECMO) has demonstrated improved functionality of transplanted organs, especially in the context of normothermic abdominal perfusion (NAP-ECMO) and normothermic thoracoabdominal perfusion (NTAP-ECMO), as reported in North America and Europe. However, this technique had not been previously implemented in Colombia.

Objective

To describe one patient managed with NAP-ECMO and another with NTAP-ECMO as part of the initial experience with the implementation of the cDCD protocol in Colombia.

Materials and methods

A retrospective descriptive case report of two patients meeting the criteria for death by type III circulatory arrest (asystole) according to the Maastricht classification. In both cases, the diagnosis of a catastrophic and irreversible condition justified the application of end-of-life care (EOLC), followed by the investigational implementation of cDCD using NAP-ECMO for abdominal organ perfusion and NTA-ECMO for thoracoabdominal organ perfusion.

Results

Two donor patients were included: a 77-year-old man for the cDCD protocol with NAP-ECMO and a 79-year-old woman for the NTAP-ECMO protocol. In both cases, the cause of death was catastrophic stroke with poor functional and vital prognosis. Total ischemia time and functional ischemia time were 66 minutes and 56 minutes for NAP-ECMO and 24 minutes and 22 minutes for NTAP-ECMO, respectively. Preservation time was 173 minutes in NAP-ECMO and 60 minutes in NTAP-ECMO. In both cases, laboratory tests for organ function were optimal, and intraoperative visualization during organ procurement and biopsies confirmed adequate viability of the organs.

Conclusions

This report of two cases confirms that implementing cDCD is both feasible and viable in Colombia. A unified multidisciplinary protocol and an integrative approach combining legal, educational, and cultural aspects are essential to ensure dignified, humane, and high-quality care for donors, recipients, and their families.