*7.7.2 En bloc retrieval of abdominal organs*

The fasted way to retrieval of abdominal organs is en bloc resection. Sometimes the time is very important for the harvesting team for example when the organs will transfer to another city by a commercial flight. In some cases, all abdominal organs should be transplanted to one recipient, for example a recipient with cirrhosis due to complete portal and superior mesenteric vein thrombosis needs a simultaneous liver-small intestinal transplantation [32]. In such cases all abdominal organs have to be procured en bloc.

According to the organs being retrieved for multivisceral transplantation, there are several ways to do such procedure [30, 33]. After the heart and/or lung team retrieved their organs, the abdominal team can complete their operation. Amphotericin B, metronidazole and sometimes diluted povidone iodine is instilled into the duodenum by a nasoduodenal tube [31]. For better exposure and preventing of bowel content spillage, usually the stomach and colon should be resected and discarded first, by stapling the esophagogastric and gastroduodenal junction and also the ileocecal and colorectal junction and transecting their vasculature. Then the sub-diaphragmatic aorta which was previously controlled is transected. All diaphragmatic adhesions of the liver and spleen are released and the infra-atrial IVC is separated with a patch of pericardium and surrounding tissue around it. At last, all the organs including aorta, IVC, liver, pancreas, spleen and small intestine are swept up of posterior abdominal wall and lumbar vertebrae and muscles and the procurement is completed by transecting the ureters at pelvic rim and iliac vessels just before entering the femoral canal [3]. All the dissections in this step should be with extreme gentleness not to push or pull any of the vital structures.
