[Special aspects of patients with va-ECMO on the way to organ donation]

The treatment of potential organ donors on veno-arterial extracorporeal membrane oxygenation (va-ECMO) is complex and resource-intensive due to the challenges of ECMO support itself and due to the severity of the underlying disease, typically associated with profound shock. This shock can lead to multiorgan failure, which can negatively impact the suitability of potential organs for transplantation; however, ECMO offers a chance for recovery of acutely impaired organs, as adequate perfusion is provided. In addition, profound pathophysiological changes can occur in the context of brain death/death by neurologic criteria (BD/DNC) which, in particular, can cause cardiorespiratory, immunological and endocrinological disorders. Specific knowledge is required concerning the diagnosis of BD/DNC as well as cardiorespiratory, gastroenterological, nephrological and coagulation-related aspects. Particularly in view of the shortage of donor organs, this group of patients should not be denied the wish for organ donation if BD/DNC occurs in the context of severe brain injury under ongoing ECMO support. The aim of this review article is to provide an overview of special aspects in the care of potential organ donors on ECMO.