Thoracic Organ Procurement Technique

The potential thoracic organ donor should have the minimum invasive hemodynamic monitoring that would allow safe preoperative and intraoperative management. Usually this requires a central venous line and upper extremity arterial catheter. Pulmonary artery balloon flotation catheters are avoided unless absolutely needed for evaluation and management of the unstable or marginal donor. Femoral arterial catheters will suffice up until the infrarenal aorta is cannulated. An arterial catheter can also be placed directly into the innominate artery intra-operatively, if required. The donor is positioned on the operating table supine with both arms tucked at the sides to allow ample access for multiple surgical teams on both sides of the operating table. The anesthesiologist plays a critical role in maintaining donor stability by maintaining proper ventilation, titrating inotropic infusions, assessing intravascular volume status, and maintaining nor-mothermia. Supranormal tidal volumes are required to eliminate areas of dependent atelectasis, which are ubiquitous in the posterior segments of the lower lobes in supine ICU patients.

Organ Procurement and Preservation, edited by Goran B. Klintmalm and Marlon F. Levy. © 1999 Landes Bioscience

Intravenous hormone administration (thyroxine, vasopressin, and cortico-steroids) is useful in maintaining donor stability. Approximately 25% of donor patients are CMV negative. Therefore, blood products are administered only through leukopore filters to limit the risk of transmitting CMV to donors (and thus to recipients). All cardiac donors undergo routine transthoracic and/or transesophageal multiplane echocardiography. When possible, cardiac donors with risk factors for coronary artery disease (age > 50 years, smoking history, a strong family history for coronary artery disease, hyperlipidemia, hypertension, diabetes, or ECHOcardiographic wall motion abnormalities) are evaluated with coronary arteriography. Ventriculography is avoided to reduce the contrast load on the donor kidneys. Ex vivo coronary arteriography by occlusive aortic injection on the dissecting table has also been reported.1

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