Between rescue and legacy: ethical reflections on organ donation after extracorporeal cardiopulmonary resuscitation.

Organ donation after extracorporeal cardiopulmonary resuscitation (ECPR) can be ethically justifiable when it remains firmly anchored in patient-centred care, respect for autonomy, and proportionality of treatment. Decisions regarding continuation or withdrawal of life-sustaining therapy require separation from donation considerations, with transparent processes and robust ethical oversight. Supporting families in decision-making is fundamental. Healthcare professionals, in turn, are moral agents whose perspectives and distress warrant recognition and institutional support. The ethical legitimacy of organ donation after ECPR rests not on outcomes achieved, but on intentions preserved, processes respected, and trust maintained. As ECPR becomes increasingly integrated into resuscitation practice, proactive ethical frameworks, advance care planning, interdisciplinary dialogue, and public engagement will be essential.