**7.7 Procurement of each organ**

## *7.7.1 Heart and lung*

Heart is easily retrieved by transecting the great vessels but this transection should be done step by step to prevent hematoma formation and injury to the vital parts especially the sinus node and pulmonary artery. When all the blood evacuated through the IVC incision, pericardium should be irrigated by cold saline at all steps to prevent warming. Cardioplegic cannula is removed. Aorta is cut just below the clamp, and SVC and IVC completely transected. The heart is gently pulled upward and inferior and superior pulmonary veins are divided one by one an at last the pulmonary trunk will be cut just at its bifurcation to remove the heart.

If the heart-lung complex is planned to be transplanted to one person, all these dissections should be avoided. The cardioplegia and pneumoplegia and prostaglandin E solutions is infused through the aortic and pulmonary artery catheters. Blood is evacuated from heart by incising the IVC and the returned blood from the lungs is evacuated through a small incision in left atrial appendages. Only the ascending aorta is transected before the innominate artery origin and the trachea is stapled after inflation of both lungs and removal of the endotracheal tube. The SVC is transected and origin of azygous vein is transligated and at last the heart -lung complex is procured by releasing their attachments to the mediastinum.

If transplantation of the lungs alone is planned, cardiac team should be left posterior wall of the left atrium intact in line with for pulmonary veins. After removing the heart, the posterior wall of left atrium and its surrounding pericardium is dissected from posterior mediastinum including the esophagus and descending and this avascular plate is continued till both lungs are released bilaterally. Small volume ventilation should be continued till all the dissections are completed and at the end and after complete inflation, the endotracheal tube is removed and trachea is stapled to extract both lungs outside the thoracic cavity.
