Organ donation after ECPR: ethical challenges and clinical implications

Area of Science:

• Cardiology
• Bioethics
• Critical Care Medicine

Background:

• Extracorporeal cardiopulmonary resuscitation (ECPR) is a life-saving intervention for cardiac arrest.
• A significant number of ECPR patients experience neurological injury or death, creating ethical dilemmas regarding organ donation.
• Organ donation pathways after ECPR intersect complex issues of life-sustaining treatment, end-of-life care, and organ preservation.

Purpose of the Study:

• To examine the ethical challenges of organ donation following ECPR.
• To address the transition from resuscitative intent to donation-oriented care.
• To propose a structured ethical model for clinicians and institutions.

Main Methods:

• This narrative review synthesizes ethical considerations and clinical challenges.
• It discusses patient autonomy, informed consent, conflicts of interest, and equity in adult and paediatric populations.
• The review proposes an ethical model based on biomedical ethics principles.

Main Results:

• Key elements of the proposed model include separating resuscitative and donation decisions, transparent prognostication, and safeguarding treatment intent.
• It emphasizes early ethics consultation and structured communication.
• ECPR-specific considerations include governance triggers, bedside tools, and paediatric perspectives.

Conclusions:

• A structured ethical model can guide responsible organ donation pathways after ECPR.
• Clear ethical boundaries and governance mechanisms are crucial for preserving public trust.
• The model aims to reaffirm patient-centered care while integrating organ donation opportunities.