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CHAPTER 48: Deceased Donor Procurement

Santiago J Miyara; Alexia McCann-Molmenti; Ernesto P Molmenti

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INTRODUCTION

OPERATIVE TECHNIQUE:

DONOR:

DECEASED DONOR PROCUREMENT

  • This chapter details the technique for abdominal multiorgan procurement.

  • Usually several surgical teams are involved in the procedure.

  • Coordination among all of those involved is essential for a successful outcome.

All figures in this chapter are reproduced with permission from Molmenti EP, de Santibañes M, de Santibañes E: Liver Transplantation: Operative Techniques and Medical Management. New York, NY: McGraw Hill; 2021.

INCISION AND EXPOSURE (FIGURE 48-1)

FIGURE 48-1

After the brain-dead donor has been correctly identified and all other requirements fulfilled as per the corresponding protocols, a midline incision from the neck to pubis is undertaken. Retractors are used to achieve complete exposure of the chest and abdomen.

A longitudinal incision is made on the body of the deceased. Retractors clasp the muscle layer apart exposing the organs within.
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In the case of donors after cardiac death (DCD), once the donor has been pronounced dead, a laparotomy is immediately performed. Aortic and inferior mesenteric vein cannulas are rapidly placed (as outlined in this chapter), the body is perfused with preservation fluid, and the organs covered with ice.

DISSECTION OF THE AORTA (FIGURES 48-2–48-4)

FIGURE 48-2

The distal aorta (yellow arrow) and common iliac arteries (white arrows) are exposed. Umbilical tapes (gray arrows) are placed proximally and distally. Early identification and access is useful in cases of surgical emergencies that require immediate cannulation and perfusion.

Arrows pointing toward the aorta and the umbilical tapes that are used to secure the aorta from both sides.
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FIGURE 48-3

Alternatively, the aorta (yellow arrow) can also be dissected just proximal to its bifurcation into right and left common iliac arteries.

A gloved hand of a person pointing to the aorta at the dissected site. An arrow points toward the aorta.
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FIGURE 48-4

The aorta (yellow arrow) has been dissected and an umbilical tape (gray arrow) placed around it. Irrespective of the approach chosen, care should be taken not to injure the lumbar branches or inferior mesenteric artery, since bleeding from these sites can be difficult to control and can impede adequate visualization.

A dissected aorta is secured on all sides by an umbilical tape. Two arrows point toward the aorta and the umbilical tape.
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DISSECTION OF THE INFERIOR MESENTERIC VEIN (FIGURES 48-5–48-7)

FIGURE 48-5

The inferior mesenteric vein (blue arrow) is identified. Ties are placed proximally and distally. Alternatively, in donors where the pancreas and/or small intestine is/are not procured, the superior mesenteric vein can be dissected at the root of the small bowel mesentery and used for perfusion.

An arrow pointing toward a dark-colored vein. Umbilical tapes secure the vein around.
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FIGURE 48-6

Inferior mesenteric vein (blue arrow).

A gloved hand using a surgical tool to extract the inferior mesenteric vein. An arrow points toward the vein.
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FIGURE 48-7

After the inferior mesenteric vein (blue arrow) is dissected for future cannulation, ties are placed proximally and distally around it. Alternatively, in donors where the pancreas and/or small intestine is/are not procured, the ...

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