Multiple Organ Retrieval: General Principles, Organ Preservation, and New Strategies

Abstract

Organ procurement is the first stage of the transplant procedure, and it decisively contributes to transplantation success or failure. In stable donors, we recommend first gaining access to the retroperitoneal space with control of the inferior vena cava and the abdominal aorta, and soon after, we recommend accurate dissection of the hepatic hilum and the recognition of any vascular abnormalities before in situ cooling. The purpose of organ preservation is to slow the unavoidable biological deterioration and damage that occurs between harvesting and reperfusion, thus buying time to organize staff and facilities, to transport organs, and, when necessary, to perform histological examinations. Simple cold storage is the most widely used preservation method, which relies on the effects of hypothermia supplemented by the use of special preservation solutions. Machine perfusion provides the unique opportunity to evaluate the functional performance of the graft prior to transplantation, likely allows a longer and safer cold ischemia time, and, in the near future, will allow the administration in the perfusion system of innovative pharmacological agents for ex vivo organ damage repair.