Multiorgan Procurement for Transplantation

This well-illustrated handbook provides answers to important questions that may arise during the retrieval of multiple organs for transplantation and offers step-by-step descriptions of current surgical techniques for procurement of the various thoracic and abdominal organs, including heart, lung, liver, intestine, pancreas, and kidney. The coverage includes detailed instruction on liver splitting techniques and on living donor liver hepatectomies and laparoscopic and robot-assisted nephrectomy for transplantation. In addition, guidance is provided on preoperative evaluation for multiorgan donation, contraindications, management for organ retrieval in deceased donors, and organ preservation. The advice offered and the questions addressed will be of relevance not only to transplant surgeons, trainees, and fellows but also to all other professionals involved in organ transplantation, including nursing staff in intensive care units and emergency rooms.

Auteur

Paolo Aseni, after his degree in Medicine at the University of Milan in 1975, trained abroad in different centers in Germany and France: at the Medizinische Hochshule in Hannover and in Zentrum für Experimentelle Medizin in München in 1978, then in the next years, at the Hôpital Beaujon in Paris and in Hôpital Paul Brousse in Villejuif. Since 1980, he has been working at the Department of Surgery and Transplant Center in Niguarda Hospital in Milan, Italy. He is currently Associate Surgeon and responsible for the surgical training in Medicina d'Urgenza Emergency Department in the same hospital. Since 1989, he has been also Assistant Professor for Anatomy and Human Macroscopic Morphology, University of Medicine, Milan.

Antonino M. Grande earned his degree in Medicine at the University of Pavia (Italy) in 1980. He trained abroad at the Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas, USA, from 1982 to 1984 and then in Marseille (France). Since 1986,he has been working as attending surgeon at the IRCCS Fondazione Policlinico San Matteo in Pavia, Italy, in the Cardiac Surgery Heart and Lung Transplant Department. Dr. Grande has also over 25 years of experience in cardiovascular postoperative intensive care; his main clinical interests include heart failure, heart/lung transplantations, and mechanical circulatory support. Between 2000 and 2010, he has been Assistant Professor for Surgical Anatomy at the University of Pavia.

Luciano De Carlis got his degree in Milan in 1979 and trained as visiting fellow at the Transplant Surgery Center in Pittsburgh (USA) in 1984, in 1987, and again in 1988, studying particular aspects in the field of liver, kidney, pancreas, heart, and heart-lung transplantation. Another important experience abroad, this time as visiting professor, was at the University of Tokyo in 2001. Prof. De Carlis has been working since 1985 at the Niguarda Hospital in Milan, Italy, specializing in particularin the field of renal, hepatic, and pancreatic transplantation. He is currently Professor of Surgery at the University of Milano-Bicocca School of Medicine, and Director of the Department of Surgery and Transplant Center at the Niguarda Hospital in Milan, where he introduced the fi rst adult living donor liver transplantation program in Italy and, recently, the fi rst Italian liver transplant program from donation after cardiac death.

Contenu

PART 1 Expanding the donor pool and evaluation of the possible organ donor.- Ethics of organ donation.- Policies for boosting donor enlistment in the North Italy transplant program macro-area.- Preoperative evaluation and arrangements for multi-organ donation: general principles and contra-indications.- PART 2 Principles of brain death diagnosis and optimal management for organ retrieval.- Brain death diagnosis.- Spinal reflexes and movements in brain death donors.- Management of metabolic and hemodynamic derangements in heart beating donors.- Non-heart-beating donors.- Multiple organ retrieval: general principles, organ preservation, and new strategies.- PART 3 Surgical technique for thoracic organ procurement.- Thoracic and mediastinal inspection and heart procurement.- Lung and heart-lung procurement.- PART 4 Surgical technique for abdominal organ procurement.- Detailed abdominal organ inspection and early surgical steps for abdominal organ procurement.- Whole liver procurement.-Split liver: surgical technique for adult-paediatric and for two adult recipients.- Small bowel and multivisceral procurement.- Pancreas Procurement.- Kidney procurement.- Vascular Homograft Procurement.- Transplantation bench surgery of the abdominal organs.- PART 5 Surgical technique for liver and kidney living donor.- Right liver lobe hemi-hepatecomy for living donor liver transplantation.- Pure laparoscopic left lateral and full-left hepatectomy including the middle hepatic vein in living donors.- Total laparoscopic right hepatecomy for living donors.- Laparoscopic and robot-assisted nephrectomy.