This report describes the clinical course of a patient who in sequence had 2 failed orthotopic lung transplants. After each transplant, she required extended periods of circulatory support via extracorporeal membrane oxygenation (ECMO). The patient was never able to be weaned from ECMO. In the end she developed extensive multisystem organ failure and expired 45 days after the initial attempt at transplantation after spending the entire postoperative time on ECMO. The family, ethical, and sociopolitical issues raised by the extended course of care for this patient are discussed.
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