*7.7.3 Liver*

In most centers liver and kidneys are the only organs used for transplantation especially when the donor has a high body mass index or marginal for any cause (unstable, diabetic, hypertensive, old age, etc.). For retrieval, these steps are necessary: transecting the infra-atrial IVC with a rim of pericardium and diaphragm, taking down the falciform, right and left triangular ligaments from the diaphragm, transecting the gastroduodenal (GD) and right gastric arteries and following the artery till the origin of the celiac artery by complete dissection of diaphragmatic crura.

If pancreas is not suitable for transplantation, dissection of the portal vein should be continued by transection of the pancreas neck anterior to SMV and swiping up the head of pancreas and duodenum to the right and the tail of pancreas to the left to expose the base of the SMV and SMA anterior to aorta. Then the origins of celiac and superior mesenteric arteries are separated from the aorta with a common Carrel patch. Replaced or accessory right and left hepatic arteries must not be jeopardized or pulled in any way and remained attached to their main large paternal vessel. Splenic vein and distal SMV SMA is transected at the level of uncinate process. IVC is transected above the renal veins' origin. Now after complete releasing of all inflow and outflow structures, the liver can be removed easily by final releasing it from the posterior wall and transferred to an organ bag and irrigated by another 1 lit of preservative solution without direct contact to ice.

If pancreas is transplantable all the dissections should be limited to upper border of the pancreas and portal vein and GD artery transected just above the duodenum and the SMV, SMA and splenic artery attachment to the pancreas be remained intact. Sometimes liver and pancreas will be removed in continuity and separated from each other in the time of back table preparation [30].
