**5. Concluding thoughts**

Although our two patients, M.J. and T.K., do not have successful outcomes with ECMO, and are unable to utilize this technology as a bridge to recovery; this does not suggest ECMO for them is simply a "bridge to nowhere." What ECMO became for them was a bridge for careful ethical considerations, meaningful family and surrogate engagement and support, shared decision-making with the healthcare team, and outcomes that preserved the quality of life at the end of life. While ECMO had to be withdrawn, it was not done hastily, and pushes the healthcare community, including clinical ethicists, to critically think about best practices, policies, and ethical guidance, and the future of ECMO for such opportunities as organ donation.
