26th Congress of the Spanish Liver Transplantation SocietyOrgan procurement“Non-Touch” Vena Cava Technique as an Improvement in Combined Lung and Liver Procurement in Controlled Donation After Circulatory Death
Section snippets
Surgical Technique
Withdrawal of life support and confirmation of death take place in the operating room. A total of 500–1000 units/kg of sodium heparin are administered before cardiac arrest. After the standard 5 minutes stand-off period, a rapid laparotomy is performed. The abdominal suprailiac aorta (Ao) is cannulated using a 20F-22F cannula and the abdominal suprailiac inferior vena cava (IVC) with a 28F cannula. Simultaneously, the donor is reintubated and the lungs are inflated with a recruitment maneuver.
Results
During 2016, 3 donors underwent NRP for liver procurement simultaneously with room-temperature perfusion for lung retrieval. Donor characteristics and timings for NRP are shown in Table 1. In all 3 donors, the addition of extra volume and blood to the circuit was required. No hemodynamic instability occurred during the NRP.
All allografts, lungs, and livers presented excellent immediate function. Postoperative results of livers are described in Table 1.
In the lungs cases, postoperative stays
Discussion
Taking into account that NRP is preferred for the abdomen and simultaneous cold perfusion followed by a rapid procurement technique for the lungs, a precise and combined technique is required in multiorgan DCD. Two surgical techniques combining thoracic hypothermia and abdominal normothermia have been described. “Bithermia preservation” [4] has been described in uncontrolled DCD and consists of a thoracic closed circuit connected to a roller pump that recirculates cold Perfadex and an abdominal
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