Standard Multiorgan Procurement from the Deceased Donor

Abstract

Organ procurement in humans to facilitate transplantation was first performed by the Soviet surgeon Yurii Voronoy in 1933. The donor was a 60-year-old man who died of a traumatic brain injury soon after admission to a Kherson, Ukraine, emergency room. A single kidney was removed 6 h postmortem and transplanted into the thigh of a 26-year-old woman dying from mercury poisoning; it produced several milliliters of urine before the patient ultimately succumbed 2 days posttransplant. Likewise, the birth of liver transplantation on March 1, 1963, by Thomas E. Starzl was possible only after successful liver procurement from a child who had died following cardiac surgery. In the 1950s and 1960s, live donors were the predominant organ source in the fledgling field of kidney transplantation. Concepts of brain death and organ transplantation had advanced on independent courses until 1963, when Guy Alexandre led a Belgian team in performing the first kidney procurement from a “heart-beating” deceased donor. His pioneering and then controversial views on brain death were first discussed in an open forum at the 1966 CIBA Foundation symposium in London. Two years later, a report issued by the Harvard Ad Hoc Committee outlined similar criteria for brain death, which provided the sound ethical and medical footing that the transplant community required to carry out organ procurement on brain-dead or “heart-beating” donors.