Liver transplantation from a non–heart-beating donor

Interest in utilizing organs from non–heart-beating donors (NHBDs) has increased because of the organ shortage. However, liver transplantation (LT) from NHBDs has been scarcely performed in Korea because only Maastricht category IV is legally permitted. We present one case of LT from an NHBD with extracorporeal membrane oxygenation (ECMO) support. The case was a 42-year-old male patient with alcoholic liver cirrhosis. The model for end-stage liver disease score was 28. The donor was a 47-year-old female who was diagnosed with brain death due to cerebral infarct, but cardiac arrest occurred before brain death was finally confirmed. Thus, venous-arterial type ECMO was initiated for circulatory support. In the operating room, asystole developed just after ECMO was stopped. After waiting for 5 minutes, cardiac death was declared. It took 6 minutes from skin incision to aorta perfusion. The recipient hepatectomy and graft implantation were performed according to the standard procedures of adult whole LT. The patient recovered from LT uneventfully and has been doing well for 9 years after LT. The use of NHBDs is a method to increase the potential pool of organ donors, thus changes toward enhanced public awareness and acceptance of donating organs, and legal support at the government level are necessary.