LAUSR

Donors after uncontrolled donation after circulatory death (uDCD) are acknowledged as a potential donor pool even if not all European countries have developed this program due to its organizational, ethical and legal issues [1–5]. On an organizational view, this program implies a synergistic interplay between the hospital (mainly the emergency physicians and the Extracorporeal Membrane Oxygenation (ECMO) team) and the emergency medical system, which timely alerts the emergency department (ED) in the presence of a person aged 65 years or less with a witnessed refractory out-of-hospital cardiac arrest (OHCA). Time is crucial for both uDCD and OHCA programs (Fig. 1), though differently. In the refractory OHCA program, time (mainly from cardiac arrest to ECMO start) is ‘brain and heart’ because it is known to affect cardiac and neurological recovery. Within the uDCD program, time (mainly from cardiac arrest to normothermic regional perfusion) affects organ viability since strictly related to ischemia-reperfusion injury (Fig. 1). Whenever the emergency physician and the ECMO team consider the patient not eligible for therapeutic ECMO [6], a uDCD program can be assessed with the involvement of the transplant coordinator [3,7].