pre requisites for cadaver kidney retrieval & technique
TRANSCRIPT
PRE REQUISITES FOR CADAVER KIDNEY RETRIEVAL & TECHNIQUE
DR. SWAPNIL TOPLEDNB UROLOGY,
YASHODA HOSPITAL, MALAKPET, HYDERABAD
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
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
Confounding Conditions andExclusions in the Diagnosis of Brain Death
Confirmatory Studies
DOCUMENTATION OF BRAIN DEATH
Algorithmic approach to achieving donor hemodynamic stability
TECHNIQUE-Cadaver donor nephrectomy without other organ retrieval
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
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
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
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
Cadaver donor multiple organ retrieval
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
The splenic vein is catheterized for portal perfusion
The gastroduodenal and splenic arteries are divided if the pancreas is not to be used
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
Returning to the right side, the duodenum and pancreas are retracted exposing the superior mesenteric artery
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
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
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