Searching new donation scenarios: potencial receptors "on the other side of the mirror"
Paula Rivera Sánchez1, Jose Moya Sánchez1, Clara Manso Murcia1, Nayara López Hernández1, María Granados Madero1, Mario Royo-Villanova Reparaz1, Tamara Puche Bolarín1, María Dolores Victoria Ródenas1, Mónica Valer Rupérez1, María del Mar Martín Magán1, Ramón Mula Martínez1, Marta Mateos Llosa1.
1Servicio de Medicina Intensiva, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
Introduction: Advances in the field of extracorporeal circulation have improved the prognosis and survival of patients in situations of respiratory failure or cardiogenic shock. However, due to disease progression or not considering the inclusion on the waiting list, the purpose of extracorporeal support treatment may be considered futile. These patients who were waiting for an organ can become new donation scenarios, placing a potential receptor just "on the other side of the mirror". The descriptively study analyzed the potential receptor of a thoracic organ with extracorporeal assistance who become donors in controlled asystole.
Methodology: Retrospective observational study of those donors who met the aforementioned criteria from January-2016 to September-2021 in a tertiary care hospital. Demographic, clinical, organ traceability, and donation effectiveness variables were collected.
Results: 9 real donors were collected. 77.8% were men with a median age of 56 years. 55% had some cardiovascular risk factor. The mean ICU stay was 12.1 days. 7 patients carried veno-arterial ECMO due to: postinfarction cardiogenic shock (4), pulmonary thromboembolism (1), primary heart transplant failure (1), non-ischemic dilated cardiomyopathy (1). 2 patients with veno-venous ECMO due to pulmonary fibrosis pending transplantation. 19 organs were obtained (7 livers and 12 kidneys), which represents a ratio of 2.1 organs per donor and an effectiveness of 88.9%.
Conclusion: The shortage of donors forces us to broaden the search for new scenarios of donation. Although this type of “mirror” donor represents a significant change in treatment and emotional stress for their families, it is a source to consider once their care team considers the adequacy of life-sustaining treatment.
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