Extracorporeal Membrane Oxygenation Prior to Death: Standardized Terminology for ECMO-Supported Organ Donation...

The expanding use of extracorporeal cardiopulmonary resuscitation (ECPR) has introduced new clinical scenarios at the intersection of extracorporeal life support and organ donation. Current donor classification systems do not explicitly address patients receiving extracorporeal membrane oxygenation (ECMO) prior to death determination, and no standardized terminology currently exists for these ECMO-supported donor pathways. This article presents a conceptual framework supported by a narrative review of the literature and an illustrative clinical scenario. Within the proposed framework, two principal ECMO prior to death (EPD) pathways are distinguished: EPDn, describing death determined according to neurological criteria during ongoing ECMO support, and EPDc, describing death determined according to circulatory criteria following ECMO withdrawal or withdrawal of life-sustaining treatment. A conceptual classification table and simplified clinical workflow are proposed. These pathways differ substantially in pathophysiology, end-of-life trajectories, donor management, timing of organ preservation, and ethical considerations. EPD terminology is intended as a complementary descriptor rather than a replacement for existing donor classification systems. Available literature suggests favorable transplant outcomes in ECMO-supported donors and increasing feasibility of normothermic regional perfusion strategies. Standardized terminology for EPD pathways may improve communication, facilitate registry development, and support future protocol standardization in transplantation medicine.