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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.

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.

FIGURE 48-3

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

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.

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.

FIGURE 48-6

Inferior mesenteric vein (blue arrow).

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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