Organ Donation Potential from Patients Receiving Mechanical Circulatory Support in the United Kingdom: A Single-Center Experience.

Abstract

Mechanical circulatory support (MCS), including extracorporeal membrane oxygenation and ventricular assist devices, is increasingly being used to manage critically ill patients with cardiac or respiratory failure. Despite advancements in MCS, many patients do not survive, raising the question of their potential contribution to deceased organ donation. This study evaluated the organ donation potential and outcomes of organ transplantation in patients receiving MCS at a UK regional cardiothoracic and transplant center. Data for all patients who died while receiving MCS in the ICU of a tertiary cardiothoracic referral center in the United Kingdom between January 2012 and November 2021 were analyzed retrospectively. These data included demographics, MCS type, cause of death, organ donation referrals, donation outcomes and recipient follow-up. Donors were categorized as a donor after brain death (DBD) or donor after circulatory determination of death (DCD). Reasons for nonreferral and nonacceptance were assessed, and outcomes of transplanted organs were followed. Of the 376 patients who died while on MCS, 208 were referred for organ donation. Sixteen patients became donors (14 DCD, 2 DBD), donating 30 organs. The most commonly donated organs are kidneys, followed by liver, pancreas, lungs, and heart. Recipients had excellent outcomes, with a median follow-up of 1,196 days and a 93% survival rate. Neurologic complications were the most frequent cause of death associated with donation. Despite concerns about donor organ quality, organ utilization rates and recipient outcomes were comparable to those of donors not on MCS. This study highlights that organ donation is feasible in patients receiving MCS, with outcomes similar to those not on MCS. Emerging technologies, such as ex situ organ perfusion, may further increase the acceptance and utilization of these organs. Patients on MCS represent an underused source of organs for transplantation. Consistent referral criteria and advancements in organ preservation technologies could enhance the potential of this donor population, providing high-quality organs and improving transplant outcomes.