# Outcomes of heart transplantation using ECMO-supported donation in brain dead donors

## TL;DR

This study examines the effectiveness of using ECMO to support brain-dead donors in South Korea to improve heart transplant outcomes.

## Contribution

The study provides insights into the success factors and outcomes of heart transplants using ECMO-supported brain-dead donors.

## Key findings

- Only 18.8% of ECMO-supported donors had their hearts transplanted.
- 1-year graft and recipient survival rates were 100%.
- Transplanted donor group was significantly younger than the non-transplanted group.

## Abstract

In South Korea, extracorporeal membrane oxygenation (ECMO) is used as a bridge to optimize utilization of heart obtained from donors after brain death. However, the heart utilization rate and the effectiveness of ECMO in donation after brain death (DBD) donors, prior to donation, remain unclear. This study aimed to analyze the early postoperative outcomes of recipients who received hearts from DBD donors supported by ECMO, and to identify the factors associated with successful transplantation outcomes.

Donors who received ECMO support were divided into two groups, one, whose hearts were successfully transplanted (n = 3), and the other, whose hearts were not utilized for transplantation (n = 13), at our institution between 2013 and 2024. Preoperative donor characteristics of the two donor groups were compared to identify the factors influencing successful heart transplantation. Recipients’ preoperative, intraoperative findings, and 1-year postoperative outcomes were analyzed.

Among 190 DBD donors, 16 (8.4%), supported by ECMO, were grouped. The transplanted heart rate in this group was 18.8% (3 out of 16 ECMO-supported potential donors). The 1-year graft survival and recipient survival rates were 100%. The transplanted donor group tended to be younger than the non-transplanted group, with a median age difference of 26 years (p = 0.031).

Prior to donation, ECMO can be effectively used in brain-dead donors, to improve the rate of heart transplants. The postoperative outcomes of recipients, who received hearts procured from ECMO-supported donors, were satisfactory. Among ECMO-supported DBD donors, the median age tended to be lower in the transplanted donor group.

The online version contains supplementary material available at 10.1007/s11748-025-02208-0.