The donor operation begins with midline laparotomy and median sternotomy for wide exposure.
The abdominal great vessels are exposed by a medial visceral rotation of the right colon and small intestine, and the aorta and inferior mesenteric vein are cannulated.
Biliary tree is flushed via the gallbladder.
After full systemic heparinization, the supraceliac aorta is cross-clamped and the intrapericardial inferior vena cava is incised to exsanguinate the donor.
Then cold-organ perfusion is initiated through the previously placed cannulas and the abdominal cavity is immersed in ice in an attempt to achieve a liver core temperature of 4°C.
University of Wisconsin (UW) solution has been used as the standard solution in the United States since 1987 when it was developed by Belzer and Southhard. This solution extended the limit of preservation to as long as 12 to 18 hours, after which the incidence of primary graft failure increases substantially
However, the acceptable preservation time depends on numerous donor and recipient variables and should still be minimized when possible. This is especially important in instances of reduced size or split-liver transplantation.
The UW solution is a hyperkalemic, hyperosmolar solution that prevents cellular swelling, maintains stable transmembrane electrical gradients upon reperfusion by preventing efflux of intracellular potassium during storage, and contains a variety of oxygen-free radical scavengers.
Recently, some centers have employed histidine-tryptophan-ketoglutarate solution because of its low potassium content and viscosity. However, this solution has not been thoroughly evaluated using long-term, randomized controlled trials. Until these data are available, UW solution remains the gold standard for organ preservation. Once the donor organ is procured, the harvest team typically transports the liver graft to the transplant center and prepares it for engraftment by a separate recipient team.