Extracorporeal Cardiopulmonary Resuscitation and Organ Donation: A Modified Delphi Study Exploring Cumulative Impact Index Feasibility

Although the goal of extracorporeal cardiopulmonary resuscitation (ECPR) remains survival with meaningful neurologic recovery, secondary contribution to organ donation is increasingly recognized. We identified standardized outcome metrics for quality improvement and reporting and explored the feasibility of developing an ECPR Cumulative Impact Index. Fourteen international ECPR experts completed a modified Delphi process to achieve these aims. Qualitative analysis of free-text responses further informed framework development. Consensus was not reached on a unified scoring index. However, participants endorsed several reporting domains with greater than 75% agreement, including cerebral performance categorization and modified Rankin score with organ donation as outcomes, and specific metric tracking pertaining to organ donation. Similarly, there was greater than 75% agreement not to stratify organ donation into neurological versus circulatory determination of death. Qualitative analysis explored five themes: death without donation, non-neurologically intact survival, organ donation benefit, score implementation, and ethical principles. Particular emphasis was placed on avoiding incentivization of cannulation solely for organ donation and understanding that the lived patient and family experience cannot be so simply summarized through numeric quantification. Ultimately, the panel agreed that while a unified ECPR beneficence score remains elusive, consensus-based outcome metrics offer a practical and ethically grounded framework for program evaluation.