A flexible procedure for multiple cadaveric organ procurement

Abstract

Techniques have been developed which permit removal of the kidneys, liver, heart and other organs from the same donor without jeopardy to any of the individual grafts. The guiding principle is avoidance with all organs of warm ischemia. This is achieved by carefully timed and controlled infusion of cold solutions into anatomic regions, the limits of which are defined by preliminary dissection.

Fig. 1

Total midline incision used for multiple organ procurement.

Fig. 2

Nephrectomy: preliminary steps for in situ infusion of kidneys in a cadaveric donor with an effective circulation who has been pronounced dead as a result of neurologic criteria.

Fig. 3

A and B, Nephrectomy. preparation for in situ infusion by encircling the aorta just above or alternatively just below the diaphragm

Fig. 4

Nephrectomy: in situ infusion of kidneys with cold preservation fluid through the distal part of the aorta, with a venous bleed-off from the distal inferior vena cava. The aorta is clamped proximally at one of the sites shown in Figure 3.

Fig. 5

A and B, Nephrectomy: removal of perfused kidneys en bloc. The kidneys and great vessels are held anterior to the plane of scissors dissection.

Fig. 6

A, Placement of kidneys in an ice basin. B, Division of kidneys using a posterior approach to split the aorta.

Fig. 7

Removal of segments of iliac arteries and veins and thoracic aorta. The vascular grafts are refrigerated and kept in case of an emergency.

Fig. 8

Hepatectomy hilar dissection and transection of the common bile duct as an initial step in multiple organ harvesting. Note that the splenic vein (or alternatively the superior mesenteric vein) is cannulated for eventual delivery of preservation fluid.

Fig. 9

In situ infusion technique used when the kidneys and liver are removed from the same donor. R.g.a., Right gastric artery; G.d.a., gastroduodenal artery; S.a., splenic artery; S.v., splenic vein; P.v., portal vein, and S.m.v., Superior mesenteric vein.

Fig. 10

Final steps if the heart is to be removed in combination with nephrectomies or hepatectomy, or both. See text for details.