Organ donation from extracorporeal membrane oxygenation and ventricular assist devices in Victoria, Australia: Characteristics and trends

Viveka K Nainani; Byron Arcia; David Pilcher; Joshua Ihle; Arne Diehl; Samuel Radford; Rohit D'Costa; Vinodh B Nanjayya

doi:10.1016/j.ccrj.2025.100102

Organ donation from extracorporeal membrane oxygenation and ventricular assist devices in Victoria, Australia: Characteristics and trends

Crit Care Resusc. 2025 Mar 13;27(1):100102. doi: 10.1016/j.ccrj.2025.100102. eCollection 2025 Mar.

Authors

Viveka K Nainani¹, Byron Arcia², David Pilcher^{1

3

4}, Joshua Ihle^{1

3

4}, Arne Diehl^{1

3}, Samuel Radford^{4

5

6}, Rohit D'Costa^{4

7}, Vinodh B Nanjayya^{1

3}

Affiliations

¹ Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.
² DonateLife, The Australian Organ and Tissue Authority, ACT, Australia.
³ The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia.
⁴ DonateLife Victoria, Carlton, Victoria, Australia.
⁵ Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia.
⁶ University of Melbourne, Melbourne, Victoria, Australia.
⁷ Department of Intensive Care, Royal Melbourne Hospital, Parkville, Victoria, Australia.

Abstract

Objective: To describe the characteristics and the trend of organ donation from donors on extracorporeal membrane oxygenation (ECMO) or ventricular assist devices (LVAD).

Design: Retrospective, observational, cohort study from June 2014 to June 2021.

Setting: A multicentre study in Victoria, Australia, using DonateLife Victoria databases.

Participants: All patients on ECMO/LVAD were referred to DonateLife for organ donation.

Main outcome measures: Number, proportion, time trend and type of organ donations from the patients on ECMO/LVAD.

Results: There were 78 donor referrals [mean (SD) age 42 (18.8) yrs, 56 (72 %) males] from patients on Veno-arterial ECMO (73 %), Veno-venous ECMO (16 %) or LVAD (6.4 %), of which 37 (47 %) donated. The annual median (IQR) referral and donation rates were 8 (5-10)/year and 4 (3-7)/year, respectively. Medical contraindications were the main reason for declining organ donation [21(51 %)]. Donation after neurological determination of death (DNDD) occurred in 20 (54 %), and donation after circulatory determination of death (DCDD) in 17 (46 %). The median (IQR) time from admission to referral for donation was longer in DCDD compared to DNDD patients. Eighty-three organs were retrieved from 37 donors (2.24 organs per donor), out of which 68 organs (82 %) were transplanted in 68 recipients. Kidneys were the most common organs retrieved (73 %) and transplanted (79 %).

Conclusion: Organ donation on ECMO/LVAD occurs only in half of the referred patients. Further studies are needed to ascertain the barriers to donations and to assess the long-term outcomes of these donations.

Keywords: Extracorporeal membrane oxygenation; Extracorporeal therapies; Organ donation; Ventricular assist device.