Donor Operation

An optimal organ procurement technique is crucial to allow adequate post-operative graft function. The guiding principle for this is the avoidance of warm ischemia in all organs. The standard guideline for organ procurement consists of three successive phases: (1) variable dissection of the organs to be used with intact donor circulation, (2) cannulation and in situ cooling by aortic infusion of the different organs with simultaneous exsanguination, and (3) organ removal. The liver is usually retrieved simultaneously with one or more other organs (heart, lungs, pancreas, kidneys, and sometimes the intestine), and there are different methods for procurement of the liver based on the organs that are being retrieved. However, the success of solid-organ transplantation has brought with it increasing waiting lists due to insufficient donation rates and substantial waiting list mortality. To increase the donor pool, the use of "extended criteria" livers, such as those taken from donors in the extremes of age, with steatosis, or with hemodynamic instability and the use of non-heart-beating donors, has become standard. However, these grafts have a higher risk of increased ischemia reperfusion injury that translates to primary graft nonfunction or delayed graft dysfunction. In some of these circumstances, it is usual to perform immediate aortic cannulation and in situ cooling, followed by en bloc recovery of the organs with subsequent division of the vascular structures and preparation on the bench.