Lecture 13

Question 1

Define Warm Ischaemia Time

Answer 1

The amount of time an organ remains at body temp after blood supply stopped

• very minimal

Question 2

What it Total WIT

Answer 2

Total Warm Ischaemia Time
- Systolic or mean BP <35-60mmHg

Controlled: <50 mmHg not enough oxygenated blood. Must wait for heart to stop beating, then wait 5 minutes (for observation) declare dead. Allow 3 minutes for family to say goodbye but most donate this important time for retrieval.

Question 3

What is True WIT

Answer 3

True Warm Ischaemia Time

- Arterial O2 saturation <25-70%

Question 4

Define Cold Ischaemia Time

Answer 4

The time between the chilling of a tissue after its blood supply has been cut off and the time its warmed by having the blood supply restored

Liver: 12-14hrs (only 30min with WIT)

Kidney: 24hrs (19min WIT, same for lung)

Question 5

What are the 3 variations of the vena cava?

Answer 5

1. Caval Replacement
2. Standard Piggyback (85% used)
3. Side to side cavaplasty (10% used)

Question 6

What are the 3 types of liver transplant?

Answer 6

• Split liver transplant
• Reduced size liver transplant
• Live donor liver transplant

Question 7

Why is DBD used for liver transplants and not DCD?

Answer 7

DBD: Heart is still working by machine so blood transport is well perfused

DCD: An urgent operation is then performed to preserve and remove organs for transplantation. This mode of cardiac death, results in increased injury to the organs during two time periods.

The first period is that between withdrawal of life support and death. As the donor’s breathing and circulation deteriorates, the organs may no longer be receiving sufficient oxygen.

The second time period constitutes the minutes immediately after death and until the organs are flushed with preservation solution and cooled (average 22 mins). As a result, livers procured from cardiac death donors are associated with an increased risk of primary non function or poor early organ function, hepatic artery thrombosis, and biliary complications.

Question 8

What is the IVC?

Answer 8

Vena Cava

Major vein that brings oxygen poor blood from the lower body back to the heart

Question 9

What is anastomosis?

Answer 9

surgical technique used to make a new connection between two body structures that carry fluid, such as blood vessels or bowel.