The Marqués de Valdecilla University Hospital has participated in an international consensus conference, supported by the European Society for Organ Transplantation (ESOT), on the use of normothermic regional perfusion with ECMO devices in donation after circulatory death—one of the areas in which the Cantabrian center has extensive experience. The work, recently published in Transplant International, is the result of a three‑year process driven by various international transplant societies with the aim of advancing the harmonization of different organ donation procedures.
The Consensus Conference, held in Bucharest, focused on four main lines of work, one of which was the use of normothermic regional perfusion with ECMO devices applied to donation after circulatory death. This line was led by Eduardo Miñambres, from the Transplant Coordination Unit at the Marqués de Valdecilla University Hospital, and Marius Berman, cardiac surgeon at the Royal Papworth Hospital in Cambridge (United Kingdom), with contributions from professionals across Europe, the United States, and Australia.
The main contribution of the work has been the harmonization of most phases of the donation‑after‑circulatory‑death process using ECMO devices, which have clearly demonstrated their ability to obtain organs in better condition for transplant recipients, even though they make the procedure more complex and require greater dedication and training from donation teams. “It is a much more laborious procedure, but it offers much better results,” explains Eduardo Miñambres. The consensus particularly addresses the use of extracorporeal devices to apply this strategy in donation after circulatory death, especially in cardiac and pulmonary donation, which are the most complex points.
Using technology that is already available
One of the main advantages highlighted by Miñambres is that ECMO devices have been available in hospitals for years to treat living patients with respiratory and/or cardiac failure. Therefore, their application in donation does not necessarily require acquiring specific technology for use in deceased individuals, but rather taking advantage of existing infrastructure and training professionals to use it in this context.
This feature also represents an economic advantage compared to other organ preservation technologies. As he explains, the ECMO‑based procedure is “extremely cheaper” than ex‑situ organ preservation machines, making it potentially beneficial for the National Health System.
Valdecilla’s commitment to this technology began in 2012 and has made the center a pioneer in organ donation and transplantation procedures. Among the milestones highlighted by Miñambres are that HUMV performed the first pancreas transplant from a donation after circulatory death in Spain in 2015, the first combined liver‑kidney transplant from donation after circulatory death in Spain in 2016, the first simultaneous heart‑lung retrieval using ECMO devices in the country in 2021, and the first neonatal cardiac donation after circulatory death in Europe in 2021. Likewise, HUMV professionals have led multiple studies published over the past decade in the top journal of the specialty (American Journal of Transplantation).
Donation after circulatory death already represents more than 50% of organ donation in Spain, with HUMV being the Spanish hospital that performed the most donors after circulatory death in 2025, both in absolute numbers and donation rate. Unfortunately, the development of donation after circulatory death is uneven worldwide. While Spain, Italy, France, the United Kingdom, and the United States have significant experience in the use of ECMO devices applied to donation after circulatory death, countries such as Canada, Japan, Australia, Germany, and most of Asia and Latin America have not yet developed it due to its complexity.
The next step is for the accumulated experience to be transferred to other countries so that more teams can develop programs of this kind. To achieve this, it will be necessary to overcome a learning curve and provide adequate training to professionals. According to Miñambres, the goal is for the use of these devices to become the procedure of choice worldwide in donation after circulatory death, given the improved survival outcomes they offer transplant recipients.
The publication of this Consensus Conference represents a step toward standardizing best practices in organ donation and promoting the development of this procedure in countries that still face barriers to full implementation. It is therefore a step toward sharing and expanding an experience that has reached significant maturity in Spain. For HUMV, the challenge remains to stay at the forefront of all aspects of organ donation and transplantation, as well as to help other countries incorporate this technology and train their teams, while taking advantage of devices that are already part of the usual infrastructure in many hospitals.
Article link: https://pubmed.ncbi.nlm.nih.gov/42558417/
