Technique of Multi-Organ Procurement (Liver, Pancreas, and Intestine)

Abstract

The growing success of liver transplantation led to the development of a flexible procedure for multiple cadaveric organ procurement as introduced by Starzl in 1984<[TS-Note: Please check, add reference to bibliography with corresponding number here. ]>. The subsequent development of pancreas, multivisceral, and intestinal transplantation has required modification and improvement of the initially described technique. Different procedures, varying from isolated procurement of the different abdominal organs to total abdominal evisceration, were described during the 1990s.

Donation after circulatory death (DCD) became reactualized during the beginning of the 21st century as a means to increase the number of donor organs. (It should be noted that the term “Non-Heart-Beating Donation [NHBD]” has been abandoned recently.) In these donors, the diagnosis of death is based on the cessation of the heartbeat and/or blood circulation. According to the Maastricht classification, proposed in 1995 by Kootstra, four DCD categories exist: Category I means dead on arrival in hospital; category II, cardiac arrest after unsuccessful resuscitation; category III, cardiac arrest after withdrawal of organ support; and category IV, cardiac arrest occurring in a brain-death donor. DCD donation is restricted mostly to Maastricht category 3 and 4 donors.