pre requisites for cadaver kidney retrieval & technique

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PRE REQUISITES FOR CADAVER KIDNEY RETRIEVAL & TECHNIQUE DR. SWAPNIL TOPLE DNB UROLOGY, YASHODA HOSPITAL, MALAKPET, HYDERABAD

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Page 1: Pre requisites for cadaver kidney retrieval & technique

PRE REQUISITES FOR CADAVER KIDNEY RETRIEVAL & TECHNIQUE

DR. SWAPNIL TOPLEDNB UROLOGY,

YASHODA HOSPITAL, MALAKPET, HYDERABAD

Page 2: Pre requisites for cadaver kidney retrieval & technique

The most immediate and practical solution to the current organ donor crisis is the maximal use and optimal management of the existing potential organ donor pool

This approach provides the greatest opportunity to enhance the conversion of potential donors to actual donors and similarly maximize the yield and quality of the organs procured from each donor

Page 3: Pre requisites for cadaver kidney retrieval & technique

Organ donor management is fundamentally a standardized process that occurs in the following sequence:

(1)surveillance to identify patients with severe neurological injury likely to progress to brain death or eventuate in withdrawal of support, establishing candidacy for donation after cardiac death;

(2)Declaration of brain death using standardized methodology and a standard protocol for withdrawal and declaration in the cases of donation after cardiac death;

(3) a uniform request for consent; and

(4) optimal medical management of the potential donor

Page 4: Pre requisites for cadaver kidney retrieval & technique
Page 5: Pre requisites for cadaver kidney retrieval & technique

Confounding Conditions andExclusions in the Diagnosis of Brain Death

Page 6: Pre requisites for cadaver kidney retrieval & technique

Confirmatory Studies

Page 7: Pre requisites for cadaver kidney retrieval & technique

DOCUMENTATION OF BRAIN DEATH

Page 8: Pre requisites for cadaver kidney retrieval & technique

Algorithmic approach to achieving donor hemodynamic stability

Page 9: Pre requisites for cadaver kidney retrieval & technique
Page 10: Pre requisites for cadaver kidney retrieval & technique

TECHNIQUE-Cadaver donor nephrectomy without other organ retrieval

Page 11: Pre requisites for cadaver kidney retrieval & technique

After widely opening and exploring the peritoneal cavity, the small bowel is retracted to expose the posterior parietal peritoneum, which is incised

This allows retraction of the bowel superiorly and to the left

Page 12: Pre requisites for cadaver kidney retrieval & technique

The duodenum and pancreas are retracted superiorly to obtain exposure of the proximal aorta and vena cava

The superior mesenteric and celiac trunks are ligated and divided several centimeters above the level of the left renal vein crossing the aorta

Page 13: Pre requisites for cadaver kidney retrieval & technique

After ligation of the proximal and distal aorta and the distal vena cava, perfusion of the kidneys is begun through the intravenous tubing that has been introduced into the distal aorta

Page 14: Pre requisites for cadaver kidney retrieval & technique

Isolation of the kidneys and ureters has been completed

The distal aorta and vena cava are transected, and the lumbar vessels posteriorly are clamped and divided, allowing removal of the entire block of tissue while cold perfusion continues

Page 15: Pre requisites for cadaver kidney retrieval & technique

Cadaver donor multiple organ retrieval

Page 16: Pre requisites for cadaver kidney retrieval & technique

The chest and abdominal cavities are entered through a long midline incision

After general evaluation of the organs to be procured and initial mobilization of the heart, the liver dissection is completed

Page 17: Pre requisites for cadaver kidney retrieval & technique

The splenic vein is catheterized for portal perfusion

The gastroduodenal and splenic arteries are divided if the pancreas is not to be used

Page 18: Pre requisites for cadaver kidney retrieval & technique

For pancreas retrieval, dissection is begun from the left, retracting the spleen and pancreas to the right, carefully preserving the splenic artery and vein

For simplicity, the superior mesenteric vessels are depicted as separate from the pancreas, but they remain closely adherent to the posterior pancreas

Page 19: Pre requisites for cadaver kidney retrieval & technique

Returning to the right side, the duodenum and pancreas are retracted exposing the superior mesenteric artery

Page 20: Pre requisites for cadaver kidney retrieval & technique

Mobilization of the kidneys and ureters from the retroperitoneum is completed, and the distal vena cava and aorta are catheterized

For illustrative purposes, the bowel, which remains attached via the mesenteric vessels, is not shown in this figure

Page 21: Pre requisites for cadaver kidney retrieval & technique

After cooling and removal of the heart and liver, the kidneys are removed by lifting the entire tissue block (left kidney not shown) anteriorly, while clamping and dividing the lumbar vessels posteriorly. IVC, inferior vena cava

Page 22: Pre requisites for cadaver kidney retrieval & technique

THANK YOU