The use of extracorporeal membrane oxygenation (ECMO) supports a patient’s respiratory or cardiovascular systems via an oxygenator and pump to enhance native function. Venoarterial support takes blood from a major vein and returns it to the arterial system when a patient has predominant cardiac failure. Venovenous support drains desaturated venous blood and returns it oxygenated to a major vein in cases of isolated respiratory failure. In recent years, ECMO has advanced from being simply a rescue therapy used when standard treatment modalities fail; more trained clinicians are approving it for novel indications.1–3 Although the skills to initiate ECMO quickly have been established with structured training programs,4 and there have been improvements to the technology to maintain extracorporeal circuits for prolonged periods to enable organ recovery or act as a bridge to further decisions on medical management, this innovative technology has presented a complex set of ethical challenges (Figure 9.1).