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

that there is a functioning sternal saw, a sternal retractor and the appropriate aortic cross-clamp. Lastly, we ensure there are 2 working and connected suctions.

About 3–5 minutes before withdrawal of care, 30,000 units of heparin are given intravenously into a central vein in the donor. The donor procurement team will then scrub in and be ready while they wait in the sterile corridor. Upon withdrawal of life support the OPO coordinator will communicate the hemodynamic status of the donor (which is the arterial blood pressure and pulse oximeter) to the team at every 5 minutes intervals. For the DCD heart while there is no set or accepted timing. From what we have seen generally, 18–23 minutes of waiting time is acceptable. Beyond this time, the heart team deems that there has been a prolonged ischemia phase. Hence, the wait time is limited to 23 minutes. In totality, the mandatory 5 minutes after cessation of electrical activity (before the patient was pronounced) and the 1–2 minutes time before the team is permitted to start brings the total time to around 30 minutes. This is the time interval beyond which the cardiac team would walk. The liver team generally waits for 30 minutes while the lung team has a more permissive waiting period of up to 60 minutes.

Then the surgical team comes in, with all their instruments already on a side table right next to the operating table. Using a knife, an incision is made all the way down to the bone. The next item is the sternal retraction. Once the sternotomy is done, the retractor is placed, and the pericardium is opened in the midline using forceps and a scissor. The heart is exposed at that point and the right atrium is cannulated with a 32 French venous cannula and this is then connected to that blood collecting bag which was handed off to the perfusion team member. He/she will then collect 1100 cc of blood at least (800–1100 cc of blood from the donor will be collected).

In the meantime, a purse-string on the aorta and a cardioplegia needle is placed in the ascending aorta. Once we have completed blood collection, the aorta is crossclamped, and we then infuse cardioplegia in standard fashion. We give 2 L of cardioplegia into the aortic root and we then packed the chest with ice. The IVC is vented and from that point on the tip of the left atrial appendage is also amputated. From that point on the procurement proceeds in standard fashion. The IVC is incised at the point where the liver team and the cardiac team agree to. Once the cardioplegia is completed, the pulmonary veins are anterior rated, the IVC transaction is completed, the pulmonary arteries are divided beyond the bifurcation of the IO at the level of the aortic arch. The SVC is divided as high as possible above the level of the azygos vein and the heart is finally explanted and is then taken onto the back table. There, instrumentation is done to place the heart on the OCS machine. We will encourage readers look for that part of the information as it is beyond the purview of this chapter.
