Deceased Donor Multi-Organ Procurement Operative Note

Date of Procedure: [Date]

Facility/OR Location: [Facility and OR location]

Donor Name: [Name]

OPTN Donor ID: [OPTN ID]

OPO: [OPO name]

Donor ABO/Subtype: [ABO type and subtype if applicable]

Donor Age/Sex: [Age] / [Sex]

Primary Abdominal Procuring Surgeon: [Name and credentials]

Assistants: [Names and roles]

Other Recovery Teams Present: [Team name, center, and organs recovered] (List each team and scope; e.g., thoracic team from [Center]—heart and lungs)

Death Pathway and Authorization

Donation Pathway: [DBD / DCD-controlled / DCD-uncontrolled / Maastricht Category]

Declaration of Death: Death declared by [provider name and role], who was not part of the procurement or transplant team, using [neurologic criteria / circulatory-respiratory criteria]. (If details unavailable, state "per OPO report." Do not infer.)

DCD Observation/No-Touch Period: [Duration in minutes] (For DCD cases only. Confirm procurement began only after completion of this period. If DBD, state "N/A.")

Authorization for Organ Donation: Authorization confirmed per OPO documentation. [For DCD/NRP: note whether authorization covered ante-mortem interventions if applicable]

Preoperative Diagnosis

Organ donation (deceased donor) for transplantation — [DBD / DCD]. [Mechanism of injury or hospitalization reason if relevant to operative findings]

Postoperative Diagnosis

Same as preoperative. [Additional intraoperative findings if any: suspected lesion biopsied / contamination noted / vascular anomaly identified / other]

Procedures Performed

• Exploratory laparotomy for organ recovery
• In situ cold perfusion and flush of abdominal organs
• Hepatectomy (donor)
• Bilateral nephrectomy (donor)
• Pancreatectomy with duodenal segment (donor)
• Small bowel recovery (donor)
• Recovery of extra vessels (iliac artery/vein grafts, aortic patch, IVC segment)
• Biopsies/cultures: [sites]

(Include only procedures actually performed.)

Key Times

(Enter times in HH:MM format. If unknown, document "Unknown — [reason]." Do not infer times or leave blank.)

Event	Time (HH:MM)
Universal
Incision Time	[HH:MM]
Heparin Time	[HH:MM / Not given]
Aortic Cannulation Time	[HH:MM]
Portal Cannulation Time	[HH:MM / N/A]
Cross-Clamp Time	[HH:MM]
Cold Perfusion Start Time	[HH:MM]
Ice/Slush Application Time	[HH:MM]
Organ Out Times
Liver Out	[HH:MM / N/A]
Right Kidney Out	[HH:MM / N/A]
Left Kidney Out	[HH:MM / N/A]
Pancreas Out	[HH:MM / N/A]
Intestine Out	[HH:MM / N/A]
Organs to Cold Storage or Machine Perfusion
Liver to Cold Storage/MP	[HH:MM / N/A]
Right Kidney to Cold Storage/MP	[HH:MM / N/A]
Left Kidney to Cold Storage/MP	[HH:MM / N/A]
Pancreas to Cold Storage/MP	[HH:MM / N/A]
Intestine to Cold Storage/MP	[HH:MM / N/A]
Packaging Complete	[HH:MM]
DCD-Specific (Include if applicable)
WLST Time	[HH:MM / N/A]
Time of Circulatory Arrest	[HH:MM / N/A]
Observation Period Start	[HH:MM / N/A]
Observation Period End	[HH:MM / N/A]
Time Death Declared	[HH:MM / N/A]
Procurement Incision Time	[HH:MM / N/A]
NRP-Specific (Include if applicable)
NRP Cannulation Complete	[HH:MM / N/A]
Cerebral Isolation Complete	[HH:MM / N/A] — Method: [ligation / clamping / balloon occlusion]
NRP Start Time	[HH:MM / N/A]
NRP Duration	[Minutes / N/A]
NRP End / Transition to Cold Perfusion	[HH:MM / N/A]

Operative Description

(Write in past tense, chronological order. Attribute actions by other teams as "per [team] report.")

Positioning/Prep/Incision: [Patient positioning, prep and drape, incision type and extent]

Initial Abdominal Survey: [Ascites, contamination, adhesions, masses, gross organ appearance]

Vascular Dissection: [Aorta and IVC exposure, portal access approach, hepatic arterial anatomy including aberrant/accessory vessels]

Cannulation and Venting: [Cannulation sites, vent sites, cross-clamp location]

Perfusion: [Solution(s) used] — [Volume(s)] — [Delivery method] — [Flush quality observations]

Organ Recovery Sequence: [Sequence and key structures preserved with each graft]

Back-Table Handling: [Inspection, trimming, identification tags, biopsy closures, repairs] (If performed by this team)

Donor Closure: [Closure performed / Not closed — reason]

Findings and Organ Assessment

Global Findings

• [Unexpected malignancy concern / infection / traumatic injury pattern]
• [Adhesions / prior surgical changes]
• [Vascular anomalies]
• [Other multi-organ findings]

(Use "Not assessed" or "Unknown — refer to OPO anatomy form" when information is unavailable.)

Liver

• Visual assessment: [Color, capsular integrity, lacerations, hematoma]
• Texture/steatosis: [Qualitative impression] (Use biopsy-confirmed percentage only if available)
• Arterial anatomy: [Celiac axis/CHA integrity, accessory/replaced arteries: confirmed / suspected / not assessed]
• Portal vein: [Length, quality, thrombus]
• IVC: [Supra- and infrahepatic cuffs, integrity]
• Biliary: [CBD division level, gallbladder flush: yes / no]
• Flush quality: [Uniform cooling/blanching vs. areas of poor perfusion]
• Injuries: [Location, depth, size, management] (If none, state "None")

Right Kidney

• Capsular/parenchymal integrity: [Intact / contusion / laceration]
• Arterial anatomy: [Single / multiple arteries, aortic patch adequacy, plaque or intimal injury]
• Venous anatomy: [IVC cuff/segment, integrity]
• Ureter: [Length, integrity, laterality tag placed]
• Biopsy: [Obtained: yes / no, closure method]
• Flush quality: [Uniform vs. patchy]

Left Kidney

• Capsular/parenchymal integrity: [Intact / contusion / laceration]
• Arterial anatomy: [Single / multiple arteries, aortic patch adequacy, plaque or intimal injury]
• Venous anatomy: [Left renal vein length/patch]
• Ureter: [Length, integrity, laterality tag placed]
• Biopsy: [Obtained: yes / no, closure method]
• Flush quality: [Uniform vs. patchy]

Pancreas

• Gland appearance: [Edema, firmness, capsular integrity]
• Duodenal segment: [Length, integrity]
• Portal vein: [Length, quality]
• Arterial stumps: [SMA and splenic: identified / tagged]
• Tail integrity: [Intact / other]
• Y-graft: [Available: yes / no, condition]
• Flush quality: [Uniform vs. patchy]

Intestine

• Bowel and mesentery: [Appearance, edema, serosal integrity]
• Mesenteric root: [Handling technique, integrity]
• Vascular pedicle: [Arterial and venous pedicles preserved]
• Enteric contamination risk: [None / low / moderate / high — rationale]

Extra Vessels

• Recovered: [Iliac artery / iliac vein / aortic segment / IVC segment]
• Quality: [Plaque, calcification, intimal injury, length adequacy]
• Packaging: [With organ / separately]

Organs Not Recovered

• [Organ]: [Reason — injury / poor perfusion / anatomic limitation / malignancy concern / time constraints / other]

(If all planned organs were recovered, state "All planned organs recovered.")

Specimens, Cultures, and Biopsies

• [Specimen type: biopsy / culture] — [Source site] — [Destination: pathology / microbiology] — [Frozen section: yes / no]

(If none obtained, state "None.")

Intraoperative Events and Deviations

Unexpected Findings: [Masses, lesions, contamination, anatomic variants, prior surgical changes] (If none, state "None.")

Injuries: [Structure injured] — [Mechanism: traction / clamp / cautery / division] — [Size/extent/depth] — [Management] — [Effect on organ usability] — [Communicated to: name, center]

Deviations from Standard Technique: [Nonstandard cannulation / altered cross-clamp strategy / altered recovery sequence / inability to procure planned vessels] — [Rationale]

(If no injuries or deviations, state "None.")

Packaging and Preservation

• Liver: [Static cold storage / machine perfusion] — [Solution] — [Destination center or "pending"] — [Handoff time: HH:MM]
• Right Kidney: [Static cold storage / machine perfusion] — [Solution] — [Destination center or "pending"] — [Handoff time: HH:MM]
• Left Kidney: [Static cold storage / machine perfusion] — [Solution] — [Destination center or "pending"] — [Handoff time: HH:MM]
• Pancreas: [Static cold storage / machine perfusion] — [Solution] — [Y-graft included: yes / no] — [Destination center or "pending"] — [Handoff time: HH:MM]
• Intestine: [Static cold storage / machine perfusion] — [Solution] — [Destination center or "pending"] — [Handoff time: HH:MM]
• Extra Vessels: [Packaged with organ / separately] — [Destination]

All organs placed in sterile triple-barrier packaging with labels verified for donor ID, blood type, organ type, and laterality. Second-person verification performed by [Name and role]. Required source documentation prepared and placed with organs per OPO process.

Communication

• [Recipient surgeon: name, center] — [Time] — [Content: injury / anatomy / biopsy / perfusion concern / other]
• Photo/video: [Obtained: yes / no] — [Depicts: description] — [Uploaded to: DonorNet / other] (If requested but not obtained, document reason)

(If no communications required, state "No intraoperative communications to recipient teams required.")

Closing

Estimated Blood Loss: [Not applicable / per local policy]

Counts: [Per OR policy / Not applicable]

Condition at End: Deceased donor; organs recovered for transplantation.

Surgeon Signature: ____________________________

Date/Time: __________________