# Diagnosis of brain death and consecutive donor management under combined circulatory support with ECMELLA therapy

## TL;DR

This paper discusses the challenges and successful diagnosis of brain death in a donor supported by a combined circulatory system, which could help increase organ donations.

## Contribution

This is the first report of brain death determination under ECMELLA therapy, offering new insights for organ donation.

## Key findings

- Brain death can be diagnosed safely in patients with ECMELLA therapy.
- ECMELLA therapy allows for organ donation despite complex circulatory support.
- The case highlights the need for adapted protocols for brain death determination.

## Abstract

Managing brain death determination (BDD) in potential organ donors is a challenging aspect of modern intensive care medicine. In critically ill patients with implanted circulatory or left ventricular support devices, standard recommendations for BDD are often no longer applicable.

The available recommendations and evidence for BDD and organ procuring under ECMELLA therapy—a combined circulatory support using a veno-arterial extracorporeal membrane oxygenation (vaECMO) and an invasive left ventricular support device (Impella® CP)—are discussed based on a clinical case. To the authors’ knowledge, this is the first report of BDD under ECMELLA therapy.

Although BDD in patients with multimodal invasive circulatory support, such as ECMELLA therapy, is demanding and time-intensive, it can still be performed safely and based on evidence. Given the continuing low numbers of organ donors, these insights may help to facilitate organ donation in patients with combined invasive mechanical circulatory support.