Grant: Project Grant

In Canada, there is an urgent need to increase the availability of organ donation opportunities and improve the quality of available grafts to optimize transplant outcomes. Despite the clear expansion and improvement of organ donation and transplantation practices in Canada, Canadians continue to die on transplant waiting lists. Death must occur prior to vital organ donation for eligible donors, which is the foundation of the "dead donor rule". In the setting of donation after circulatory death (DCD), withdrawal of life-sustaining measures (WLSM) is undertaken and organ donation commences after death. While the emergence of DCD has increased organ donation, a greater duration of warm ischemic time between WLSM and death determination is associated with poor graft function and outcomes in transplant recipients. A post-mortem strategy of initiating extra-corporeal membrane oxygenation (ECMO) after death determination has been championed as an effective strategy to mitigate and reverse the harmful effects of warm ischemia on the eligible grafts. Although effective, concerns have been raised that this technique could invalidate death determination by reperfusion of the brain. As such, using comprehensive neuromonitoring, we aim to evaluate the presence or absence of brain function and perfusion during post-mortem ECMO. Demonstrating absence of both would add credence to the adherence to the dead donor rule, increase heart donation opportunities and improve graft viability for other visceral organs by mitigating warm ischemia pathophysiology in the donor.