Organ Preservation

Abstract

The rapid deterioration of an organ deprived of its blood supply was referred to in Chapter Two. Individual organs differ in their susceptibility to ischaemic damage. Thus at normal body temperature the critical periods before irreversible destruction occurs are 3–5 minutes for the brain, 15–20 minutes for the liver, 30–40 minutes for the heart and lung, 50–100 minutes for the kidney, and up to 6 hours for skin and cornea. It is obviously desirable for the time lag between the onset of ischaemia and restoration of nourishment to the graft to be as short as possible, but excessive haste is unnecessary in removing the cornea for grafting, whilst every minute is of critical importance for a liver transplant. With a living kidney donor, elaborate preservation techniques are not used ; instead, the operations on donor and recipient are synchronized so that the recipient is ready to receive the graft before the transplant is removed from the donor. Since restoration of a blood supply to the graft only takes 15–30 minutes, the kidney can be transplanted without cooling, but it is usually preferable to chill the organ. This can be done by immersing it in cold saline and/or infusing a cold physiological solution into the renal artery by gravity drainage from a blood transfusion drip-stand (Fig. 26).