CHEST Guidelines-Rebuttal-From-Dr-Warren-et al

Rebuttal-From-Dr-Warren-et al_chest

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The document discusses the complex issue of using extracorporeal membrane oxygenation (ECMO) as a bridge to transplant evaluation (BTTE) for patients with end-stage lung disease (ESLD) who are not yet listed for lung transplantation. It highlights the ethical considerations of withholding potentially life-saving treatments like ECMO-BTD in cases where it could benefit patients referred late to transplant centers. The authors argue that while early referral and increased organ donation are ideal, they don't address the immediate needs of patients awaiting transplants.<br /><br />Dr. Warren and colleagues refute this proposition, highlighting that expert opinion generally does not support BTTE. They argue that patients suitable for BTTE while on ECMO are rare and that most lung transplant and ECMO centers lack the volume needed for positive outcomes with this approach. Additionally, the criteria proposed for patient selection are deemed impractical, as many patients with ESLD have not undergone transplant evaluations due to referral delays. Transporting these patients to specialized centers is likewise challenging, given their unstable conditions and the limited availability of ECMO transport programs.<br /><br />The document concludes that while ECMO as BTTE is not routinely practiced, early referral for transplant evaluation and advocacy for organ donation remain critical. Ultimately, the focus should be on addressing the systemic issues leading to referral delays while balancing ethical responsibilities to provide immediate care options like ECMO for suitable patients.

Keywords

ECMO

bridge to transplant evaluation

end-stage lung disease

ethical considerations

transplant referral delays

organ donation

ECMO transport programs

lung transplantation

systemic issues

immediate care options