Current and Future Developments in Surgery

The following chapters give a succinct reference about how the system is set up, including how organs are listed and allocated and then distributed, for a reader like a resident or fellow trying to understand how organs go from donor to implanted organs, as well as the role of the OPO and what governs your efforts and success.

The determination of brain death criteria has been the cornerstone of organ donation since 1968 when the Ad Hoc Committee at Harvard established medical definitions. It continues to stand the test of time as a means to establish medical and legal criteria for all transplant professionals in the field to rely upon and maintain the public’s trust in the organ procurement system. This chapter reviews the origins of these criteria as well as the current application of neurologic criteria to determine brain death. It further reviews updated guidelines from the neurological professional community affirming these criteria and conduct of the brain death determination.

The goal of this chapter is to review the currently Public Health Service defined increased risk donors and discuss management of recipients of these donor organs.

This chapter examines the effect of brain death physiology on potentially recoverable organs and provides specific management recommendations for the care of the multi-organ donor. We also review the logistic considerations important for successful procurement. The goal of these aims is to optimize function and maximize recovery of life-saving organs.

The objective of this chapter is to review the principles of organ preservation and current preservation solutions employed in multi-organ transplantation with specific reference to unique organ specific preservation.

Cardiac allograft evaluation and procurement are integral parts of the multiorgan donation process as cardiac function prior to brain death determination often has a critical impact on multiorgan function. In this chapter, the authors review the basic principles of cardiac assessment as well as maintaining cardiopulmonary function during the period after brain death determination to enhance overall cardiopulmonary as well as abdominal organ perfusion and function. They also review acceptable donor criteria, expanding the donor criteria to enhance organ availability, preservation solution selection and techniques and donor-recipient selection and matching to improve post transplant success.

Donor lung assessment has evolved significantly as experience grows in the field of cardiopulmonary transplantation and organ donors are more actively managed with consideration of their pulmonary function. This chapter evaluates the current criteria employed in many centers evaluating traditional assessments of oxygenation and ventilation to avoid early graft dysfunction secondary to ischemia-reperfusion injury using modern ventilator and preservation fluids and techniques.

Liver procurement is a complex surgical procedure requiring a detailed knowledge of technique, anatomy as well as anatomical variants. A thorough assessment of both the recipient and donor is necessary to optimize graft procurement, prevent complications and the possible loss of a life-saving organ. Standard liver procurement involves warm dissection of the pertinent structures followed by a rapid cold perfusion phase and subsequent evisceration. The surgical technique, as well as common pitfalls and special scenarios are discussed in this chapter with the aim of providing the reader with a comprehensive understanding of liver procurement.

Pancreas transplantation is experiencing a resurgence in interest as one of the last frontiers in multiorgan transplantation. Most commonly performed in combination with kidney transplantation, this chapter reviews key aspects of donor assessment as well as preservation and anatomic recovery to enhance success of these procedures. Pancreas transplantation in Donation after cardiac death is also reviewed as an evolving potential source of organs in this field.

Living Donation of kidneys and liver has been an important component of organ donation since the field’s inception. Living donation requires meticulous examination of potential donors, both to ensure the safety of the donor and assure that the organ is well suited to the recipient. These procedures must be done in a safe and highly reliable way to avoid short and long term complications for the donor. In this chapter, we review specific nuances and recovery techniques in living liver and living kidney donation procedures.

In this chapter, we review the technical nuances and donor-recipient matching principles of the adult-pediatric split liver donation and living donor transplant process. Specific attention is paid to the safe conduct of the procedures, which in the case of living donation, have high stakes consequences for both the recipient and the donor.

Islet cell transplantation has evolved as a viable alternative to solid organ pancreas transplantation. In this chapter, we review the important donor characteristics and techniques for successful islet cell procurement and transplantation.

Extending the donor organ pool has been a long-standing goal of the transplant community given the inadequate supply of donor organs in comparison to the number of patients on the transplant waiting list. ex vivo preservation techniques are now evolving as a viable means to accomplish these goals. In this chapter, we review and explore the currently available techniques and potential for ex vivo preservation of solid organs.