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Updated: Jul 7, 2026
Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
Organ Donor Potential After Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest: A
Hanne C R Verberght1,2, Thijs S R Delnoij3,4, Martje M Suverein3
1Department of Surgery, Maastricht University Medical Center+, Maastricht University, Maastricht, the Netherlands.
Insights
Extracorporeal cardiopulmonary resuscitation (ECPR) may increase organ donor identification in refractory out-of-hospital cardiac arrest (OHCA) patients. This intervention provides crucial time for assessing organ donor suitability, potentially saving more lives through transplantation.
Area of Science:
- Cardiology
- Transplantation Medicine
- Critical Care
Background:
- Refractory out-of-hospital cardiac arrest (OHCA) often leads to death or withdrawal of life support.
- Extracorporporeal cardiopulmonary resuscitation (ECPR) offers ICU admission for OHCA patients but survival remains challenging.
- ECPR may provide extended time for evaluating organ donor potential.
Purpose of the Study:
- To assess the impact of ECPR on identifying potential organ donors in OHCA patients.
- To compare organ donor rates between ECPR and conventional CPR (CCPR).
Main Methods:
- Post-hoc analysis of the multicenter INCEPTION trial (NCT03101787).
- 134 OHCA patients randomized to ECPR or CCPR.
- Transplant physicians evaluated patient reports for liver and kidney donation suitability.
- Intention-to-treat and as-treated analyses were performed.
Main Results:
- Potential organ donors were identified in 20% of ECPR patients versus 6% of CCPR patients (p=0.038).
- In the as-treated analysis, 27% of ECPR patients were potential donors compared to 0% of CCPR patients (p<0.001).
- This included 9% potential kidney donors and 27% potential liver donors.
Conclusions:
- ECPR, while used for life-saving purposes, can also increase the number of potential organ donors after cardiac arrest.
- Selected OHCA patients undergoing ECPR may become suitable organ donors.
- This highlights a dual benefit of ECPR in critical care scenarios.
Background:
Extracorporeal cardiopulmonary resuscitation (ECPR) is a potentially life-saving intervention in refractory out-of-hospital cardiac arrest (OHCA). ECPR enables, in most of the treated cases, ICU admission to patients who otherwise would have died at the emergency department (ED). Still, many of them die, frequently after withdrawal of life-sustaining therapies due to irreversible critical conditions and related complications. The additional time provided by ECPR, however, might allow for the assessment of organ donor suitability. The aim of this study was to evaluate the impact of ECPR on the number of potential organ donors after refractory OHCA.
Methods:
We performed a post-hoc analysis of the multicenter INCEPTION trial, which randomized 134 OHCA patients between conventional CPR (CCPR) and ECPR. Detailed patient reports were presented to transplant physicians to determine the acceptability of the liver and kidneys for organ donation. In addition to the intention to treat analysis, we performed an "as-treated" analysis, limited to patients arriving without return of spontaneous circulation (ROSC) at the ED.
Results:
Out of 70 patients randomized to ECPR and 64 to CCPR, potential organ donors were identified in 14 (20%) and 4 (6%) patients, respectively (χ2 test, p = 0.038). In the as-treated analysis, 15 out of 55 (27%) treated with ECPR were potential donors, compared to 0 out of 59 treated with CCPR (p < 0.001). This included five (9%) potential kidney donors and 15 (27%) potential liver donors.
Conclusion:
Although ECPR is currently used with life-saving intentions, it may simultaneously increase the number of potential organ donors following cardiac arrest in selected patients.
Trial Registration:
ClinicalTrials.gov identifier: NCT03101787.
