**5. Type, volume, and pressure of preservation solution**

Historically, blood is the first perfusate that was used for organ preservation [18]. After that, Alexis Carrel reported the first n0n-bood solution named Tyrode's solution which can preserve cat thyroid tissue viable for 3–21 days [18]. In 1960s hypothermia added to blood or serum for better survival of kidney grafts. Since then, static cold storage (STS) by perfusion of the organs by cold (0–4°C) solutions was accepted as the gold standard for organ preservation till now [18]. Collin's solution (invented in 1969) and then Euro-Collin's (1980) were the standard solution for organ preservation for next two decades and at last University of Wisconsin (UW) solution was invented by Belzer in 1985 [19]. This solution is low Na+ , high K+ solution like intracellular fluid (ICF) which was the gold standard for organ preservation for at least 2 decades.

Histidine-tryptophan-ketoglutarate (HTK) (low Na<sup>+</sup> , high K+ with cardioplegic effects) and Celsior (high Na+ , low K+ ) solutions are next preservative fluids which was initially used only for heart transplantation in 1990s which were much cheaper and very soon, UW was replaced by these solutions in all abdominal organ transplantations in some transplant centers [18]. Although, these solutions have lower cost and lower viscosities, but till now, UW is the standard solution for heart transplantation in most centers [20]. IGL-1® (Institute George Lopez-1) liquid is another low viscosity solution which reversed electrolyte concentration compared with UW (K+ 25 meq/l, Na + 120 meq/l) with lower cardiac complication and some centers proved that with the use of this liquid, the results of liver and kidney transplantation will be better.

High K<sup>+</sup> concentration of this solution made them unsuitable for lung transplantation because of high risk of pulmonary vasoconstriction [20]. Perfadex® (a low-potassium dextran glucose solution) was invented with characteristics of extracellular fluid for this purpose in late 1980s and since then then is used as the standard preservative for lung transplantation [18].

In multiorgan procurement procedure which is a routine procedure in high volume transplant centers, each team usually used its preferred solution for individual organ transplantation. For example, cardiac and abdominal teams may choose HTK or UW solution but pulmonary team uses Perfadex®, and when a heart-lung transplantation is performed en-bloc in one person, then they should use a cardioplegic solution first and after that Perfadex® for pulmonary preservation. **Table 1** shows the characteristics of most popular different preservation solutions which are commercially available now.

Another dilemma that should be resolved is the rate and pressure of preservative solutions. Perfusion by a cold perfusate in not a physiologic process and most teams


*Surgical Techniques of Multiorgan Procurement from a Deceased Donor DOI: http://dx.doi.org/10.5772/intechopen.94156*


**Table 1.**

*Characteristics of different popular preservation solutions.*

accepted the 80–100 cm H2O (1 m gravity pressure) as the acceptable pressure for all organs and 150 cm H2O for aortic infusion [10]. With the advent of machine perfusion, it is shown that target arterial flow of 0.25 mL/minute/g and target v0nous flow of 0.75 mL/minute/g liver tissue and mean arterial and portal venous pressure of 30–50 and 8–10 mmHg, respectively, are the acceptable rates for liver transplantation and these figures could be extrapolated to the multiple abdominal organ retrieval procedure [21]. Higher pressure for portal vein irrigation is definitively deleterious for post-transplant function of the graft. For pancreas transplantation
