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phentolamine, to prevent vasospasm and to ensure more uniform flushout of the intraabdominal organs. Likewise, the heart/lung team may administer prostacyclin, also a vasodilator, during the procurement. Once the SVC is occluded, the aorta is clamped just proximal to the innominate artery, cardioplegic solution infused, and the caval atrial junction at the level of the diaphragm incised. At the same time, infusion of 1-2 liters of University of Wisconsin (UW) solution is begun via the aortic cannula. The portal vein is then incised, cannulated, and infused with 1 liter of UW solution. Once the heart or heart-lung block is removed, the liver and pancreas are removed followed by removal of the kidneys either en bloc or separately according to the retrieval team preference. Figure 5.1 depicts the appearance of the liver, pancreas, and kidneys after dissection as well as placement of aortic and portal vein cannulas just prior to removal. After removal, the liver and pancreas are flushed with an additional 200-300 cc UW solution via the SMA, celiac artery, and portal vein and stored in sterile plastic bags on ice at 4°C. If the liver and pancreas are being used at different centers, they are separated and stored separately prior to transport.

Fig. 5.1. Cadaver donor multi-organ retrieval. Reprinted with permission requested from: Sollinger HW, Odorico JS, D'Alessandro AM et al. Transplantation. In: Schwartz SI, ed. Principles of Surgery, ed. 7. New York, McGraw-Hill, 1998:361-439.

Fig. 5.1. Cadaver donor multi-organ retrieval. Reprinted with permission requested from: Sollinger HW, Odorico JS, D'Alessandro AM et al. Transplantation. In: Schwartz SI, ed. Principles of Surgery, ed. 7. New York, McGraw-Hill, 1998:361-439.

The kidneys, if removed en bloc, are usually separated by dividing the vena cava and aorta longitudinally. This will allow identification of multiple renal arteries from within the aorta without risk of injury. If the kidneys are to be machine perfused instead of cold stored, they may be cannulated en bloc if multiple renal arteries are present or individually if single arteries are present bilaterally. En bloc perfusion requires ligating all lumbar arteries, suturing the proximal aorta, and cannulating the distal aorta. Again, the kidneys are flushed with additional UW solution, placed in sterile plastic bags, and placed on ice at 4°C.

An alternative, rapid en bloc technique of organ retrieval may be used with DCD donors or in donors who have become hemodynamically unstable or who have had cardiac arrest (Fig. 5.2). This technique involves cannulating the femoral artery and vein or the distal aorta and vena cava, clamping the thoracic aorta, and dividing the esophagus, sigmoid colon, and ureters. While flushing the femoral artery or aorta with UW solution, all intraabdominal organs are removed en bloc by dissecting retroperitoneally starting at the level of the diaphragm and ending at the distal aorta and vena cava which are divided. The portal vein is flushed

Fig. 5.2. Rapid en bloc retrieval of all intraabdominal organs. Reprinted with permission requested from: D'Alessandro AM, Hoffmann RM, Knechtle SJ et al. Successful extrarenal transplantation from non-heart-beating donors. Transplantation 1995; 59:977-982.

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