**8.1 If only 1 surgeon performing procurement**

If only 1 surgeon is available on the procurement team, the steps occur as described until flush occurs with the Perfadex solution. The chest is then packed with ice and ventilation continues. The lung procurement surgeon will scrub out. The surgeon will then along with the anesthesia team intubate the patient, perform bronchoscopy, and initiate ventilation. The surgeon will then scrub back in and continue to harvest in the previously described fashion.

### **8.2 DCD heart only placed for transplantation (OCS)**

The process of DCD heart only procurement with Organ care system (OCS) is a relatively new technology, which will be discussed in this section. For this procedure, it is very important to ensure that two surgeons are present as part of the procurement team. The reason for this will become more relevant as the discussion of the technique ensues. After the patient's hemodynamic status, drips, lactates, troponins, echo, and other vital parameters have been checked out the procurement team proceeds to the donor center and there the traditional checklist is followed. These include (but are not limited to) the blood groups and that the UNOS IDs being checked. At that point, the procuring team and the local organ procurement organization (OPO for short) will familiarize themselves with the local institutional/hospital protocol. The donor team will park the Transmedics-organ care system (OCS) in one of the corners of the operating room, plug in the power, ready the equipment and will ensure that every object, instrument, and machine is given a green signal for the procedure. The patient is prepped and draped in sterile fashion and all lines are passed off. The cardioplegia is spiked and ready to be infused at short notice. We make sure
