Background: Although donation after circulatory death has been successfully implemented for heart transplantation in several countries, it has not yet been adopted in South Korea. Consequently, extracorporeal membrane oxygenation (ECMO) may represent a potential strategy to enhance donor utilization rates. This study aimed to analyze the proportion of ECMO application among brain-dead donors, the rate of heart utilization in these cases, and recent trends in heart utilization in South Korea. Methods: Between 2015 and 2023, data from the Korean Network for Organ Sharing registry were analyzed to determine the proportion of brain-dead donors who received ECMO support. Among these donors, the number of hearts utilized for transplantation and those not utilized were identified, and the underlying reasons for nonutilization were examined. Results: Donors receiving ECMO support constituted a small proportion of the total donor population. The ECMO application rate ranged from 1.7% to 4.5% and demonstrated a gradual increase over time. Among ECMO-supported donors, heart utilization was low during the early study period but increased progressively after 2020. The most common reason for nonutilization was classification as medically unsuitable for transplantation. Conclusions: Between 2015 and 2023, the donor heart utilization rate among ECMO-supported brain-dead donors increased gradually after 2020. However, a substantial proportion of donated hearts remained unused, underscoring the need for detailed investigation of the underlying causes and implementation of strategies to improve donor heart utilization.
Lee et al. (2026) studied this question.