CHEST Guidelines-POINT--Should-Patients-With-Advanced-Lung-Disease-

POINT--Should-Patients-With-Advanced-Lung-Disease-

Pdf Summary

The article debates the ethical and medical appropriateness of offering extracorporeal membrane oxygenation (ECMO) to patients with advanced lung disease as a bridge to transplant (BTT) before they are officially listed for a lung transplant. 

<strong>Proponents' Viewpoint:</strong>
The proponents argue for considering ECMO as a bridge to decision-making (BTD) for such patients, emphasizing the lack of therapeutic alternatives and the uniformly fatal progression of end-stage lung disease (ESLD). They suggest that offering ECMO-BTD could give patients a chance to qualify for a life-saving transplant. The focus is on an individualized decision-making pathway based on patient selection criteria, such as access to specialized transplant centers, expected wait time on ECMO, multidisciplinary consensus, and informed consent. Despite limited data, evidence indicates that ECMO-supported patients can survive to transplant with outcomes comparable to those who did not receive such support pre-transplant.

<strong>Opponents' Viewpoint:</strong>
Opponents argue against using ECMO-BTD, citing the shortage of donor organs and the potential poor outcomes from ECMO use compared to non-ECMO cases. They highlight that ECMO should be reserved for patients who have already been evaluated and are on the transplant wait-list, given their demonstrated need and potential benefit from ECMO. Offering ECMO to those not yet on the list could divert resources and potentially lead to poor utilization of limited medical capabilities. 

In conclusion, while ECMO presents a possible lifeline for those nearing transplant eligibility, the authors emphasize the importance of cautious and rigorous patient selection to prevent ECMO use from becoming a futile intervention. They suggest a multidisciplinary approach to evaluate both the potential benefits and the ethical implications of ECMO-BTD for patients not yet on the transplant list.

Keywords

ECMO

lung transplant

bridge to transplant

end-stage lung disease

patient selection

ethical considerations

medical appropriateness

donor organ shortage

multidisciplinary approach

informed consent