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This book is a compilation of common and uncommon surgical and ancillary techniques that we have found useful in the multiorgan transplantation pro gram at the University of Minnesota. Descriptions of these techniques are not available at a single source elsewhere. Use the book as a teaching aid, a source of workable techniques, and as a reference for individuals with relatively little experience in a particular area of transplantation. Because of the varying levels of expertise of our readers, vascular access is described in exquisite detail, as it is aimed at an audience of individuals who want to learn the fine points about how to prolong the function of shunts. The chapter on organ preservation is aimed at the surgeon or beginning technician who must learn how to do it from scratch--even the catalogue numbers of the necessary equipment are included. In contrast the chapters on heart, liver, and pancreas transplantation, while omitting fine points of suture technique, concentrate on the essential principles and safeguards. Individuals contemplating such transplants are presumably already schooled in the fine points of surgical technique. The chapters on cadaver organ donation are perhaps the most innovative. They represent our attempt to reorganize organ donation in a way that will provide the greatest usefulness of each donor as a source for multiple organs for transplantation. We hope that the book will become available to centers that, while not performing liver, pancreas, or heart transplants, wish to serve as donation centers.
List of contents
I Access for Dialysis.- 1 General Principles of Access Surgery.- Preoperative Assessment.- General Operative Strategies in Access Construction.- A Practical Guide to Access Selection for the Individual Patient.- References.- 2 Venous Access for Short-Term Hemodialysis: Percutaneous Femoral Vein Cannulation.- Technique of Percutaneous Femoral Vein Cannulation.- Postdialysis Care.- Complications of Percutaneous Femoral Vein Cannulation.- References.- 3 Venous Access for Short-Term Hemodialysis: Percutaneous Subclavian Vein Cannulation.- Principles of Subclavian Vein Cannulation.- Equipment for Subclavian Puncture and Subclavian Vein Cannulation.- Technique.- Postoperative Catheter Care.- References.- 4 Venous Access for Hemodialysis in Children: Right Atrial Cannulation.- Principles of Right Atrial Cannulation in Children.- Equipment for Silastic Right Atrial Cannulation in Children.- Techniques.- Postoperative Care.- References.- 5 Arteriovenous Communication: External Shunts.- Principles of Shunt Placement.- Equipment for External Arteriovenous Shunts.- Techniques.- Postoperative Care.- References.- 6 Arteriovenous Communication: Internal Fistulas.- General Technical Considerations.- Equipment for A-V Fistula or Shunt Construction.- Technique for Radial-Cephalic Fistula.- Alternative Sites for an A-V Fistula.- Alternatives in Construction of Internal A-V Fistulas.- Conversion of a Shunt into an A-V Fistula.- Combined A-V Fistula with Hemasite(TM) Device.- Postoperative Care After A-V Fistula Construction.- References.- 7 Arteriovenous Communication: Bridge Grafts.- Choice of Materials for the Bridge Graft.- Technical Consideration in the Construction of A-V Bridge Grafts.- Technique of Loop Forearm Graft.- Postoperative Care.- Alternative Bridge Grafts.- References.- 8 Complications of Vascular Access.- Hemorrhage.- Occlusion and Threatened Occlusion (Poor Access Function).- Infection.- Aneurysm and Pseudoaneurysm.- Hemodynamic Complications.- Neuropathy.- References.- 9 Peritoneal Dialysis.- History.- Principles of Peritoneal Dialysis.- Types of Peritoneal Access Devices.- Technique of Placement of Peritoneal Catheter.- Complications of Peritoneal Catheter Insertion.- References.- II Organ Donation.- 10 Multiple Organ Donation from a Cadaver.- General Aspects of Cadaver Donation.- Logistics of Cadaver Organ Donation.- Guidelines for Determination of Death.- Problems of Histocompatibility Between Cadaver and Donor Recipient.- Evaluating the Potential Function of Organs from Single Donors.- Maintenance of the Donor Prior to Organ Donation.- Surgical Strategy for Multiple Organ Donation.- Removal of Lymph Nodes for Tissue Typing and Crossmatching.- Technique of Multiorgan Donation: The Heart, Liver, Kidneys, Tail-of-Pancreas.- Use of Extracorporeal Circulation for Multiorgan Donation.- References.- 11 Whole Pancreas Donation from a Cadaver.- Selection of Cadaver Pancreas Donor.- Management of the Donor.- Intraoperative Strategy.- Operative Technique.- 12 Distal Pancreas Donation from a Living Relative.- Rationale for Living Related Versus Cadaveric Pancreas Donors.- Preoperative Evaluation of the Pancreas Donor.- Preoperative Care of the Donor.- Operative Care of the Donor.- Removal of Distal Pancreas from a Related Volunteer: Technique.- Postoperative Care of the Donor.- Complications.- References.- 13 Volunteer Kidney Donation from a Living Relative.- Ethical Problems.- Donor-Specific Transfusion.- Strategy of Organ Retrieval from a Related Living Donor.- Technique of Living Related Donor Nephrectomy.- Postoperative Management.- References.- Organ Preservation, Transportation, and Sharing.- Kidney Preservation Techniques.- Removing the Kidney from Perfusion.- Donor Information and Organ Preservation Sheet.- Surgical Manipulation of the Kidney During Perfusion or Prior to Cold Storage.- Organ Sharing.- Preservation Techniques in Other Organs (Pancreas, Liver, and Heart).- References.- III Organ Transplantation.- 15 Heart Transp
