Il prelievo multiorgano. Note di tecnica chirurgica ed aspetti organizzativi

A substantial increase in the activity of organ transplantation has been observed in Italy during last few years. The optimization of multiple cadaveric organ procurement requires cooperation of various surgical teams. We describe here our standard procedure for heart, lungs, liver, pancreas and kidney retrieval which has been utilized and verified in more than 300 human donors. The surgical technique is flexible and can be changed when haemodynamic instability of the donor is present. The technique is based on the general principle of organ perfusion by specific cold solutions. The liver, pancreas, and kidneys are perfused through a catheter placed in the abdominal aorta and in the inferior mesenteric vein. The heart is perfused via the aortic root and the lungs through the pulmonary artery. A vascular clamp is placed on the ascending aorta just below the innominate artery and another clamp is placed on the supracoeliac aorta in order to separate the abdominal from the thoracic compartment. The cooperation and synchronization of different surgical teams seem now necessary in order to optimize the results during multiple organ harvesting