Purpose: Although donation after circulatory death (DCD) has been successfully implemented for heart transplantation in several countries, it is not yet adopted in South Korea, making extracorporeal corporeal membrane oxygenation (ECMO) a crucial tool for expanding the donor pool. This study aims to analyze the proportion of ECMO application among donation after brain death (DBD) donors, the utilization rate of hearts in these cases, and recent trends in heart utilization rates.
Method: Between 2015 and 2023, data from the Korean Network for Organ Sharing registry were analyzed to assess the proportion of DBD donors who received ECMO support. Among these donors, the number of hearts utilized for transplantation and those deemed non-utilized were identified, and the underlying reasons for non-utilization were examined.
Result: The overall number of donors remained stable over the years without significant fluctuations. Although donors receiving ECMO support constituted a small proportion of the total donor population, the ECMO application rate varied between 1.7% and 4.5%, demonstrating a gradual increasing trend over time [Fig 1]. Among donors supported by ECMO, the heart utilization rate for transplantation was low during the initial period (2015–2019) but has progressively increased since 2020 [Fig 2]. The most common reason for non-utilization was that the donations were deemed unacceptable due to medical causes [Fig 3].
Conclusion: Over the past nine years, the average donor heart utilization rate was found to be 7.8%, with a gradual increase observed since 2020. This suggests that the application of ECMO may contribute to reducing the number of non-utilized hearts. However, a significant proportion of donated hearts still remain unused, highlighting the need for a detailed investigation into the underlying causes and the implementation of strategies to enhance donor heart utilization.