Extracorporeal cardiopulmonary resuscitation (eCPR) is a highly resource-intensive procedure, and its cost-effectiveness remains a subject of debate [1]. Hospital-based eCPR for refractory out-of-hospital cardiac arrest has been shown to have a low probability of cost-effectiveness compared to conventional cardiopulmonary resuscitation (cCPR) [2]. A recent cost-effectiveness analysis reported an incremental cost-effectiveness ratio (ICER) of €121,643 per quality-adjusted life year (QALY) gained for eCPR. This places eCPR in the cost-effectiveness plane quadrant characterized by higher costs and greater effectiveness. At a willingness-to-pay threshold of €80,000 per QALY, the probability of eCPR being cost-effective was estimated at only 36% [2].

However, the potential benefit of organ donation from patients with unfavorable eCPR outcomes is an important factor often overlooked in cost-effectiveness analyses of eCPR. Such analyses should account for the additional value derived from otherwise unattainable organ donations facilitated by eCPR. This omission may lead to a significant underestimation of its overall cost-benefit profile. The contribution of organ transplantation to improving long-term quality of life and healthcare efficiency is well-established.