*Thoracic Organ Procurement during Multi-Organ Retrieval DOI: http://dx.doi.org/10.5772/intechopen.95793*

artery are divided, at which point the trachea is exposed and looped. The trachea is then stapled at 60% tidal volume. The lungs are then taken to the back table and given 250 cc's of retrograde flush through each pulmonary vein [13]. There are different ways of effectively conducting the retrograde flush. Some do it in situ in the chest, while others take the lung bloc to the back table. We prefer taking it to the back table and use 250 cc's of perfadex per vein so in total about a liter of retrograde flush (amongst all four veins).

One technique is a foley catheter with an inflated bulb at the tip; inserted into each vein sequentially as the flush is administered. The caveat with this is that one may inadvertently injure the pulmonary vein ostium (which is delicate) by excessively distending it. The other technique, personal communication from Dr. Hassan Nemeh at Henry Ford Health System, is to use a retrograde cardioplegia catheter which has a self- inflating balloon, so it is much more elegant and less traumatic [14]. The only problem with this is it is not part of the standard kit, so the procurement surgeons must remember to bring it with them. Yet another technique that can be used is to utilize the rubber tubing that comes on the end of tubing. Insert the tube into the pulmonary vein and then pinch the vein to provide a tight seal. Whichever technique may be used, note that it is important to have the perfadex solution only 30 cm above the table and run it by gravity; avoid delivering it at excessive pressure which can lead to pulmonary edema!

When the retrograde flush is being perfused be sure to inspect the pulmonary artery for any clots. It is not uncommon to see tiny emboli. If, however large clots are seen, it is important to alert the implanting surgeon who might either choose to abandon or repeat a retrograde flush at the implanting center. Some teams are utilizing EVLP in such situations. After completion of the retrograde flush look inside the PA to assess if there are any clots remaining.
