Organ procurement

Organ procurement

Anesthesia type	None required typically
Airway	ETT
Lines and access	PIV, arterial line
Monitors	Standard, ABP
Primary anesthetic considerations
Preoperative
Intraoperative	No anesthesia required. Hemodynamic control and volume status may be adjusted per surgeons
Postoperative
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An organ procurement is performed on a patient who is clinically deceased in order to harvest organ(s) for transplantation. The anesthetic plan is simple, but there can be a lot of nuance depending on the organs being procured and the needs of the surgical team.

Overview

Indications

Procurement of organs following brain death or cardiac death

Surgical procedure

• Variable based on which organs are being recovered
• Generally, includes a subxyphoid-to-pubis incision +/- sternotomy

Preoperative management

Patient evaluation

System	Considerations
Airway	Should already be mechanically ventilated
Neurologic
Cardiovascular	Maintaining organ perfusion pressure is crucial. Patients are typically on multiple vasopressors
Pulmonary
Gastrointestinal
Hematologic
Renal	Brain dead patients can develop diabetes insipidus and may require vasopressin
Endocrine
Other

Operating room setup

• Fluids: crystalloid and albumin for volume repletion
• Pressors and dilators for tight BP control
• Diuretics: mannitol (e.g. 25 g) and furosemide (e.g. 40 mg) are typically requested by surgeons
• Steroid (e.g. methylprednisolone 1000 mg)
• Anticoagulation with heparin for aortic cross clamp

Patient preparation and premedication

Different hospital institutions may have special traditions that are done for the family of the donor.

Regional and neuraxial techniques

N/A

Intraoperative management

Monitoring and access

• Standard ASA monitors
• Arterial line for close hemodynamic monitoring to ensure appropriate organ perfusion

Induction and airway management

• Generally no induction of anesthesia is needed
• Patient should be adequately oxygenated to avoid hypoxia to organs

Positioning

Supine

Maintenance and surgical considerations

• No anesthesia is needed
• Careful hemodynamic control is needed. Have vasopressors and vasodilators available
• Complete paralysis
• Mannitol and furosemide may be requested ~15 min prior to aortic cross clamp
• High dose of heparin (e.g. 30,000 units) is used immediately prior to aortic cross clamp

Emergence

Once organs are accepted and have arrangements for delivery, aorta is cross clamped and organ procurement commences. Anesthesiology is not needed after aortic cross-clamp.

Postoperative management

Disposition

N/A

Pain management

N/A

Procedure variants

	Variant 1	Variant 2
Unique considerations
Indications
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications