Donor selection and procurement of multivisceral and isolated intestinal allografts

Purpose of review: Intestinal transplantation is accepted therapy for adults and children suffering from intestinal failure. Donor selection and correct allograft procurement are paramount to the success of intestinal transplantation. This review details current opinion on donor selection and performance of multivisceral and isolated intestinal procurement. Recent findings: To optimize immediate allograft function, donor selection has been restricted to optimal candidates according to defined criteria. Size matching is an important consideration in donor selection. Donors typically range from 50% to 1 20% of recipient weight. However, larger organ(s) can be surgically reduced to fit the abdominal cavity of a child. Accepting larger donors improves allocation and decreases waiting list morbidity and mortality. Living-donor intestinal transplantation remains controversial because of the underutilization of potential cadaver donors; however, it provides potential benefits including immuno-modularity. The procurement techniques herein are a modification of the original descriptions of Starzl. All procedures begin with the standard techniques of abdominal organ procurement. Multivisceral organ procurement requires tailoring the donor procedure to the individual needs of a recipient. The essential element of multivisceral and liver/intestine allograft procurement is maintenance of the superior mesenteric artery-portal vein axis. When the liver is a component of a multivisceral allograft, our preference is to preserve the integrity of the biliary system through inclusion of donor duodenum and pancreas. Organ cold perfusion is performed with University of Wisconsin (UW) solution® (Viaspan, Pomona, NY) at 4°C through the aortic and inferior mesenteric venous cannulas. Summary: Correct procurement is fundamental to the success of multivisceral and isolated intestinal transplantation. The techniques described herein can be routinely applied by recovery teams at remote donor facilities without additional equipment or impedance to concomitant thoracic and abdominal organ procurement.