PRELEVEMENTS D'ORGANES CHEZ L'ENFANT. ASPECT CHIRURGICAL

Today, in every child in situation of organ donor, a multiple organ harvesting is performed which requires surgical techniques more precise, in order to improve the results. Heart, heart-lungs and liver transplantation represent in children, for volume reasons, situations where harvesting must be performed in a child matched for height with the recipient. Today a technique of unique harvesting took place of the initial techniques which required careful dissection of all organs, the preparation of organs being made secondarily, after refrigeration and harvesting. The first step is abdominal and sets up a device of abdominal spraying. The second step is the thoracic dissection, heart or cardio-pulmonary block harvesting being performed by the cardiac surgery team. Finally, the third step consists of the harvesting of the abdominal viscera. It is preceded by a precooling, begun during the period before thoracic dissection. It supposes a global cooling of the liver, kidneys, duodeno-pancreatic block and small bowel. Mono-block dissection then begins with the liberation of the liver and eventually of the duodeno-pancreatic block. After hepatectomy, both kidneys are harvested in monoblock. The intestine, itself, is harvested in last position. Progresses should occur, due to the improvement of the performances of the cooling solutions.