Extracorporeal membrane oxygenation (ECMO) is used in severe cardiorespiratory failure refractory to conventional management, often as a bridge to recovery, long-term support, or transplant. However, some patients might not be candidates for destination therapy at the outset, and others might die or lose their candidacy due to complications, which are more likely the longer ECMO is continued.¹ When patients remain ECMO-dependent with no prospects of recovery, and when they are not candidates for destination therapy, the patient, their next of kin, and the health-care team face an ethical dilemma: what next?