Extracorporeal membrane oxygenation (ECMO) is a new technology used to rescue patients with severe circulatory or respiratory failure and help bridge them to recovery or to definitive therapies like device implantation or organ transplantation. The increasing availability and success of ECMO has generated numerous ethical questions about its use and potential misuse. This commentary on a case of a patient who is no longer a candidate for transplant but wishes to continue ECMO identifies strategies clinicians can use to reconcile competing responsibilities.

ECMO is a form of mechanical circulatory support that involves continuously circulating a patient’s blood through a circuit that oxygenates and decarboxylates blood using a semi-permeable membrane. In VV-ECMO, oxygenated blood is returned to the venous circulation and pumped through the arterial circulation by the patient’s heart.

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