Sequence of Abdominal Organ Procurement

Abstract

Background: Where all organs were accepted and, after inspection, are found to be suitable for transplantation, the following sequence of abdominal organ procurement is recommended: small bowel, pancreas, liver, kidneys. The small bowel is the most sensitive organ for ischemia; therefore, it is retrieved first.

The second organ to be procured from the abdomen is the pancreas followed by the liver or vice versa. Liver and the pancreas could also be retrieved en block and split on the back table. In some cases, the pancreas should be offered up for the liver (small donor, very difficult recipient, anatomical abnormality), especially when the risk of arterial damage due to anatomical abnormality or thrombosis is high and the arterial vascularization is uncertain. Finally, the kidney(s) is/are the last organ(s) to be procured. There are many different surgical techniques concerning kidney retrieval with splitting in the abdomen in situ or procurement together followed, if necessary, with splitting on the back table. For many reasons, in most donation procedures, the small bowel is not accepted for procurement and transplantation. In a small number of cases, if the small bowel has been accepted it is procured by the regional procurement team, but more usually by the transplant surgeons from the small bowel recipient centre.

In this chapter, I pay special attention to describe step by step the most frequent occurrence facing the regional procurement surgeon when the small bowel is not procured from the abdominal cavity and the rest of the organs are procured.

Conclusions: A good surgical procurement technique and very good knowledge of human anatomy are the two important things, which allow you proper recognition of the most important vascular abnormalities during organ dissection. These two skills will help you to avoid surgical mistakes, which would otherwise lead to organ damage.