Techniques of organ procurement and preservation of liver and pancreas

The continuously improving success rate in transplantation imposes an obligation to implement the treatment for the increasing number of waiting recipients. In consideration of the increasing number of waiting recipients, all suitable organs of one donor should be harvested, including both liver and segmental or whole pancreas. The supreme goal of multiple organ harvesting is to ensure that none of the organs are damaged during preparation, perfusion and removal of one of the other organs. In general, several surgical teams are involved in multiple organ harvesting. The procedure therefore has to be highly standardized. One of the most important aspects of the procedure described here is the well-defined division into individual preparatory phases, each with its specific objectives: Phase I: preparation of organs, including evaluation of their suitability and delineation of important anatomical structures. Phase II: special preparations immediately before start of perfusion. Phase III: perfusion. Phase IV: removal of organs. Phase V: additional procedures and preparation of donor's body. Phase VI: preparation of transplant outside of body. This chapter describes the procedure by which liver and whole pancreas can be harvested from one donor. The surgical technique represents a compromise between two extremes: excessive dissection before perfusion and perfusion as the first step. The procedure described herein is considered to be an effective, safe, rapid and reasonably standardized one, especially for the co-operative effort between different surgical teams.