Liver transplantation from a non-heart-beating donor

Area of Science:

• Transplantation Medicine
• Organ Donation
• Cardiopulmonary Support

Background:

• Increasing organ shortages necessitate exploring alternative donor sources, such as non-heart-beating donors (NHBDs).
• Liver transplantation (LT) from NHBDs is limited in Korea due to legal restrictions, primarily permitting only Maastricht category IV donors.
• Extracorporeal membrane oxygenation (ECMO) offers potential for circulatory support in NHBD scenarios.

Observation:

• A case of adult whole liver transplantation from an NHBD is presented, utilizing ECMO for circulatory support.
• The donor experienced cardiac arrest before final brain death confirmation, necessitating ECMO initiation.
• The procedure involved a 6-minute organ procurement time, followed by standard LT recipient hepatectomy and graft implantation.

Findings:

• The recipient, a 42-year-old male with alcoholic liver cirrhosis (MELD score 28), recovered uneventfully from the LT.
• The patient has remained well for 9 years post-transplantation, demonstrating long-term graft survival.
• This case highlights the successful application of NHBD liver transplantation with ECMO support.

Implications:

• Utilizing NHBDs can significantly increase the availability of organs for transplantation.
• Enhanced public awareness and acceptance of organ donation are crucial for expanding NHBD programs.
• Government-level legal reforms are necessary to facilitate broader implementation of NHBD liver transplantation.