| Organ transplantation is the most effective or the sole therapeusis for those who are suffering from end-stage organ failure. Medical science, especially transplantation medicine has been developing more and more rapidly after the dawn of the 21st century was shining upon our planet. Twenty-five years ago, with the development of the immunosuppressive therapy, the short-term outcome of the allograft was much more improved, which resulted in the large-scale development of renal transplantation in China. In recent years, liver transplantation has developed rapidly, and the technical level of organ transplantation has become an important indicator of the technical level of a hospital, or even a district and a country.The procurement of the donor organs is the first step, as well as the most important step of organ transplantation. Without high-quality donor organs, there will be no successful transplantation. So the whole transplantation society has focused more and more upon the quality of donor organs. This pilot study, aiming at the improvement of the quality of donor organs, was developed to optimize the surgical technique of organ procurement, as well as to better the organ preservation solution.PART I The establishment of the modified method of combined liver and kidney procurement.In 1996, for the first time in China, we established the method of rapid donor liver procurement, on which our modified method of combined liver and kidney procurement were based.The main improvements of our method of combined liver and kidney procurement include: 1. Superior mesenteric vein, after exposed under the head of pancreas, is cut open and cannulated to douche the liver. This method of portal veincannulation, which needs much less time and shortens the warm ischemia time, can also avoid injuries to mutated liver artery. 2. The liver is douched through the portal vein with 1000ml HCA organ preservation solution, followed by 2000ml UW solution. Because UW solution is too ropy and dense, its slow flowing speed may impede fast cooling of the liver. So, douche with the two solutions helps to shorten the warm ischemia time of the liver. 3. The liver is douched through the liver artery with 2000ml HCA solution, followed by 1000ml UW solution. Then, the liver artery system is filled with UW solution throughout the whole preservation period. This helps to reduce the morbidity of bile duct complications after the operation. 4. During the procurement of the liver, the gall bladder is cut open, and douched with equilibrium liquid or HCA solution to flush out bile, which is proved to harm the mucosa of the bile duct. After the procurement, the common bile duct is also cut and douched with UW solution. All these managements are proved to reduce long-term bile duct complications after the engraftment.The instillation canals, manufactured by ourselves, have advantages such as follows: 1. The caliber of instillation canals is larger, and the flush speed is higher. 2. The instillation canals form a complete set with both UW and HCA solution bags. It's very easy to connect the canals with both of the bags during the procurement operations. 3. The instillation canal for the aorta has a balloon in the head, which helps to block the abdomial aorta very easily. 4. A rubber loop is added to the head of the instillation canal for the portal vein. This little alteration helps to prevent the slippage of the canal from the portal vein during the procurement. 5. The instillation canals, which have now been produced in batches, are convenient to carry and easy to use.The technique for the detachment of the liver from kidneys has also been bettered so that the injuries to kidney vessels can be avoided.In conclusion, compared with the method of rapid donor liver procurement which we had employed for a long time, our modified method of combined liver and kidney procurement markedly shortens the time of organ procurement, with quitegood organ quality and less accidental injuries. This method is also easy to learn and to put into practice.
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