The Abdominal Organ Protective Effect Of ECMO For Unstable Brain-dead Donors

Objective: 1. To observe the changes of the function of unstable brain-dead donor abdominal organs(liver and kidney) and the clinical effect after renal transplantation by using the extracorporeal membrane oxygenation. 2. To explore the clinical operational procedures of the application of ECMO technology in the maintenance of organ function of unstable brain-dead donors. Methods: Our center had 80 C-I donors, also is the donation after brain death(DBD) from July 2014 to July 2015, 22 cases all had severe hemodynamic instability before organ acquisition, and the organ function had been damaged in different degrees. Our topic group was the first to apply ECMO technology in this kind of donor at home and had form a specific method of flow: after a rigorous brain death decision and a legal instrument for the identification of organ donation, femoral artery and vein catheterization, According the V-A ECMO type bypass 6-17 hours, obtain donor liver and donor kidney under ECMO. Collected the data of hemodynamic indexes(blood pressure, heart rate and arterial oxygen partial pressure, central venous pressure), hepatic and renal function(creatinine, urine volume, total bilirubin, valley pyruvic transaminase, aspartate aminotransferase) and vasoactive drug dosage(norepinephrine, dopamine) of these cases at different time point(befor using ECMO, With ECMO 1 hours later, 3 hours, 5hour, 7 hours and before organ acquisition). collected the data of the out-put and utilization of donor liver and kidney, and the incidence of complications of renal transplant recipients in our center. Statistical analysis of the collected data. Results: Hemodynamic parameters were gradual stabilizated, the dosage of vasoactive drugs were significant reduced, donor liver and kidney function index tended to turn for the better during ECMO bypass for the 22 unstable DBD donors. 22 cases were getted 44 kidneys and 22 livers in which 41 kidneys and 16 livers coud be used for transplant recipient, the rate of output was 93.2% and 72.7% respectively. The donor livers were diverted to other transplant centers, 41 kidneys were transplanted to 41 patients in our center. All the course of operations were smooth and postoperative occurrence delayed graft function(DGF) in 9 cases(22%), acute cellular rejection(AR) in 2 cases(4.9%), 41 cases were cured and discharged. Conclusions: 1. The essence of organ dysfunction of unstable brain-dead donors is the hypoxia of the tissues and cells, the goal of organ function recovery is to correct tissue hypoxia. ECMO ensures continuous and stable oxygenation and perfusion for tissue. Application of ECMO in unstable brain-dead donors can:(1) repair and improve the quality of abdominal organ;(2)increase the number of potential donors;(3) improve the rate of output of donor abdominal organs;(4) reduce post transplant complications and the incidence rate of delayed graft function and/or primary non-function;(5) ensure the safety of recipients of organ transplantation. 2. The clinical operation process of the maintenance of organ function which is using ECMO in unstable brain-dead donors is proposed preliminarily in our country.