*3.1.7. Insertion of the perfusion cannula into the aorta for cold perfusion (in situ cooling of the organs)*

A cold perfusion line is set up at this stage, and a large cannula is connected to the perfusion line. The air bubbles are removed from the line.

**Figure 7.** A segment of the aorta under the diaphragm dissected and slung with a nylon tape.

After heart-lung dissection, Heparin 25,000 IU is given intravenously. The distal part of the aorta is tied by pre placed Dacron tie just above the bifurcation of the common iliac arteries. A vascular clamp is placed onto the aorta about 5 cm proximally to this tie to block the blood flow to this segment of the aorta where an arteriotomy is made. The cannula is inserted via arteriotomy and is tied by a pre placed Dacron tie. The cannula is secured and the vascular clamp is removed. At this point, the cold perfusion is commenced simultaneously with cardiothoracic perfusion. The IVC is divided just below the right atrium above the diaphragm for draining the blood and perfusion fluid. Attention is made to leave adequate length of IVC with the liver at suprahepatic end. Alternatively, incision of IVC can be made at the lower part just proximal to the level of confluence of common iliac veins. A suction tube can be placed into the vena cava for adequate drainage of the perfusion fluid. At least, three sets of suction line are used to have proper evacuation of the blood and fluid during perfusion period. At the same time, the ice slush is poured into the abdominal cavity over the liver, pancreas, kidney, and intestine for immediate topical cooling of the organs. Usually, 2 L of Hartman fluid is used for initial flush of the blood followed by 4 L of UW preservation solution. The organs are checked in the meantime to ensure that the progression of perfusion is adequate. The in situ cold perfusion takes about 20 min.

is checked, and the IVC is transected. The IVC is lifted anteriorly by insertion of a finger from the suprahepatic end, and its posterior side is dissected to reach the suprahepatic end. The posterior side of the IVC is dissected superiorly to the level of division just below the atrium. Care is taken during IVC dissection without jeopardizing the quality of renal vein for kidney transplantation. The right hepatic triangle ligament is dissected, and part of the diaphragm is taken with the liver during the procurement. The liver is now removed freely from the abdomen and immersed in the ice-slush filled basin (**Figure 8**). One technical point is that the liver laceration is easy to occur at the location where the adhesion band is present. Therefore, gentle handling of the liver is emphasized during the dissection and procurement of the liver

Procurement of Abdominal Organs in Multi-Organ Donation in Deceased Donor

http://dx.doi.org/10.5772/intechopen.77308

41

The pancreas can be retrieved in favor with liver as an en bloc as described in a separate paragraph. Here, we describe a technique for pancreas retrieval as a subsequent procedure following the liver procurement. A 6/0 Prolene suture is placed at the transection of the port vein and splenic artery, respectively, as a mark during the liver procurement if known the pancreas is also procured. A segment of duodenum is routinely procured with the pancreas as exocrine drainage. A GIA stapler is used to divide the duodenum from the stomach distal to the pylorus. Care is taken to ensure that the NGT tube is positioned proximal to the pylorus without being caught in the GIA stapler. A reload GIA is needed to divide the distal part of the duodenum at the level of the fourth part of the duodenum or at the beginning of the jejunum. The distal part of the SMA and SMV is tied, respectively, by pre placed 2/0 Vicryl tie and divided. The transverse mesocolon is divided to free the inferior edge of the pancreas. On the left the dissection is continued to the splenic flexure and on the right to the duodenocolic ligament, which are divided together with the root of mesentery. So, the pancreas with attached duodenum is now free from its attachment. Then, the pancreas is lifted

at all times to avoid the potential injury.

**Figure 8.** Liver graft harvested and immersed in ice slush.

*3.2.3. Procurement of the pancreas*
