Organ Procurement Flashcards
Where is the cannula placed for the Heart?
Aortic Root
Where is the cannula placed for the Lungs?
Pulmonary Artery
Where is the cross clamp placed?
Distal to the aortic root, typically aortic arch
If abdominals only may be Supra Ciliac Aorta in order to keep thoracic cavity closed
What is done to allow for venous drainage?
Vena Cava is incised after cross clamp
Where is the Venous cannula placed for the portal flush (aka Pre Cool) (3 options)
1st- Portal Vein
2nd- Inferior Mesenteric Vein
3rd- Splenic Vein
Abdominal Venous Drainage location
chest cavity or
Inferior vena cava at the level of the illiac bifurcation
Euro- Collins or Collins
oldest- cheapest Simple Crystalloid high glucose high potassium low sodium mimic intracellular environment. once had Mg in original formulation. Originally known as Euro- Collins; called collins once Mg removed
Viaspan UW (Belzer’s)
“gold standard”
aka SPS static preservation solution
Heart cold time
Max cold time 4-6 hrs
Heart Solutions
Cardioplege
UW
HTK
Celsior
Lung Solutions
Pulmoplegia
Perfadex
UW
Euro- Collins
Lung cold time
Max cold time 4-6 hrs
Liver perfusion happens through what cannula?
Abdominal AORTIC cannula
Liver Solutions
UW
HTK
Celsior
low viscosity preservation solution
primarily used for hearts
can also be used in liver, pancreas, kidneys
Liver Cold Time
Max Cold time 24 hrs
preferred <12hrs
Pancreas Cold Time
6-12 hrs
Pancreas cannulation
no direct cannulation or perfusion
Kidney Cannulation
Aortic cannula placement is same as liver
Distal Aorta proximal to the illiac bifurcation
Liver Cannulation
Aorta proximal to the illiac bifurcation
Internal Packaging
A triple sterile barrier must protect all organs
Which organs REQUIRE a rigid container as one of the triple layers?
Kidneys
Pancreas
Extra vessels
Mandatory info on internal packaging label
- Description of the contents of the package,
- donor ID,
- blood type and blood subtype, if used for allocation.
Before Cross clamp what is used to prep AORTA?
2 umbilical tapes
aortic cannula will be placed between these
What is used to prep the Superior Mesenteric Artery for ligation?
heavy ties
Left Kidney
Generally preferred for transplant
Longer renal vein
Cuff of aorta should be present
Should have PATCH of Vena Cava
Cuff
Renal Artery still connected to a piece of the aorta
Patch of the Cava
Renal vein remains connected to a section of the Vena Cava
Typically on Left Kidney
Right Kidney
Shorter renal vein
Should have FULL Vena Cava
Cuff of aorta should be present
Heart Storage Volume
1 Liter
HTK
CUSTODIAL
Pancreas preservation solutions
UW
HTK
Perfadex
Intestine preservation solutions
UW
HTK
Normal Hepatic Artery anatomy
Classic branching of the common hepatic artery from the coeliac artery, and the proper hepatic artery into right and left hepatic arteries to supply the entire liver
replaced hepatic artery
one which arises from an anomalous origin and supplies a portion of the liver solely.
(commonly replaced right hepatic artery arising from the SMA
or replaced left hepatic artery arising from the left gastric artery)
accessory hepatic artery
arises from an anomalous origin and supplies a portion of the liver along with another artery.
What vein CANNOT be used for cannulation if recovering pancreas?
The Splenic Vein is preserved and must not be used for cannulation during pancreas recovery
(Inferior Mesenteric Vein is dissected and cannulated)
what vasculature does the Panc need for transplant?
- 2 cm of Portal Vein must remain on the pancreas side after cold preservation.
- Portal Vein is divided between the liver and the pancreas
- Splenic Artery ligated close to Celiac Axis to leave as much length as possible with the pancreas
Portal Cannulation
The cannula is placed into the Portal Vein through the Inferior Mesenteric Vein for portal venous perfusion
R Hepatic Artery anomaly and panceas recovery
If the Right Hepatic Artery passes through the head of the pancreas, the pancreas cannot be recovered.
Pumped kidneys max cold time
72 hrs
Longer preservation times associated with Graft Failure, resulting in the need for dialysis until the ATN resolves.
During recovery, plaque is noted in the distal aorta and surgeon is unable to cannulate the distal aorta due to plaque. What would he cannulate instead?
Cannulate the descending thoracic aorta
On the back table you notice the kidneys appear mottled? What do you do?
Suggest back table flush
Liver pre-cooling solution most commonly used?
LR?
Vessels and tissue typing material is stored in what?
FDA approved preservation solution
in a secured refrigerator with a temperature monitor
When should you pull the cardioplege flush solution from the cooler?
?
Order of recovery in multi organ OR
1- Heart 2- Lungs 3- Liver 4- Pancreas 5- Small Intestine 6- Kidney
kidney only procurement
- Thoracic cavity typically remains closed
- cannulation- distal aorta
- cross clamp- supraceliac aorta
- exsanguination- vena cava incised
Liver Procurement
- Cross clamp: Supraciliac Aorta
- Cannulation: Aorta & Portal Vein
- Exsanguination: Vena Cava is cut at level of R Atrium
Kidney cold time (static preservation)
30 hrs
Vessels
Storage time
14 days
if HIV,HCV, HBV negative
What can extra vessels be used for
Extra vessels must only be used for organ transplantation or modification of an organ transplant
Who is responsible for
the Reporting Requirements for Extra Vessels
Transplant hospitals must report to the OPTN Contractor (UNOS) the disposition of all extra vessels, including their use, sharing, or destruction, within seven days of their use, sharing, or destruction.
Extra Vessel packaging (8)
- Donor ID
- Donor blood type
- Donor blood subtype, if used for allocation
- Recovery date
- Description of the container contents
- That the extra vessels are for use in organ transplantation only
- IDT
- PHS risk status
