Mansour Marwa, Okhuysen-Cawley Regina, Doane Katherine, Jacobs Lauren, Coleman Ryan, Lam Fong Wilson, Ontaneda Andrea
Division of Critical Care, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.
Division of Pediatric Hospice and Palliative Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.
Pediatr Transplant. 2025 Feb;29(1):e70013. doi: 10.1111/petr.70013.
Pediatric solid organ transplantation is challenging due to the limited availability of suitable organs resulting in an increasing waitlist. Many pediatric transplant recipients receive organs from deceased donors, often after neurologic determination of death. Organ donation from patients on extracorporeal membrane oxygenation (ECMO) at the time of death has been described in adults, offering the potential for donation after circulatory determination of death (DCDD) with minimal ischemia time.
DCDD on ECMO requires a coordinated and seamless approach from a multidisciplinary team for clinical care. In this article, we aim to describe our institutional DCDD practice guidelines, which involve withdrawing ECMO support in the pediatric intensive care unit (PICU) or the operating room (OR), followed by organ procurement after the declaration of death, and our experience with DCDD in 2 pediatric patients on ECMO. In case 1, withdrawal of life-sustaining therapies (WOLST) occurred in the PICU with transport to the OR for DCDD. In case 2, both WOLST and DCDD occurred in the OR. In the described context, ECMO provided hemodynamic stability with minimal warm ischemia time for the donated organs.
This approach offers a novel resource for pediatric organ transplantation, potentially expanding the pediatric donor pool.
由于合适器官的供应有限，导致等待名单不断增加，小儿实体器官移植面临挑战。许多小儿移植受者接受来自已故供体的器官，通常是在进行神经学死亡判定之后。成人中已有关于在体外膜肺氧合（ECMO）支持下死亡时的器官捐献的描述，这为循环死亡判定（DCDD）后的器官捐献提供了可能，且缺血时间最短。
ECMO 支持下的 DCDD 需要多学科团队在临床护理方面采取协调且无缝衔接的方法。在本文中，我们旨在描述我们机构的 DCDD 实践指南，该指南包括在儿科重症监护病房（PICU）或手术室（OR）撤除 ECMO 支持，随后在宣布死亡后进行器官获取，以及我们在 2 例接受 ECMO 支持的儿科患者中进行 DCDD 的经验。在病例 1 中，在 PICU 进行维持生命治疗的撤除（WOLST），随后转运至 OR 进行 DCDD。在病例 2 中，WOLST 和 DCDD 均在 OR 进行。在上述情况下，ECMO 为捐献器官提供了血流动力学稳定性，且热缺血时间最短。
这种方法为小儿器官移植提供了一种新资源，有可能扩大小儿供体库。
