Clinical Challenges in Transplant Surgery: Deceased Donor Abdominal Recovery - A Step-by-Step Guide

Behind The Knife: The Surgery Podcast

Education, Science, Health & Fitness, Medicine

4.8 • 1.4K Ratings

🗓️ 9 February 2026

⏱️ 47 minutes

🔗️ Recording | iTunes | RSS

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Summary

Abdominal organ procurement is a high-stakes operation that blends anatomy, speed, and coordinated teamwork. In this Behind the Knife episode, the UNMC transplant team walks through the practical “how-to” of deceased donor abdominal recovery—covering OR roles and logistics, key anatomic maneuvers, cannulation/flush troubleshooting, and the workflow differences that matter most between donation after brain death (DBD) and donation after circulatory death (DCD).

Hosts
Madeline Cloonan, MD PhD – General Surgery Resident, University of Nebraska Medical Center (@maddie_cloonan)

Evelyn Waugh, MD – Transplant Surgery Fellow, University of Nebraska Medical Center

Jacqueline Dauch, MD – Abdominal Transplant Surgeon, University of Nebraska Medical Center

Alex Maskin, MD – Kidney & Pancreas Transplant Surgeon, University of Nebraska Medical Center

Learning Objectives

Compare DBD vs DCD donor workflow and define total vs functional warm ischemia.
Identify key OR roles and the ethical/legal separation of death declaration from procurement teams.
Outline the core steps of abdominal procurement, including exposure, cannulation, cross-clamp, and organ removal sequence.
Apply a practical troubleshooting approach when flush flow is inadequate

References

Englesbe MJ, Mulholland MW. Operative Techniques in Transplantation Surgery. Philadelphia, PA: Wolters Kluwer; 2018.
Tullius SG, Rabb H. Improving the supply and quality of deceased-donor organs for transplantation. N Engl J Med. 2018;378(20):1924–1933. doi:10.1056/NEJMra1708700. https://pubmed.ncbi.nlm.nih.gov/29768153/
Croome KP, Barbas AS, Whitson B, et al. American Society of Transplant Surgeons recommendations on best practices in donation after circulatory death organ procurement. Am J Transplant. 2023;23(2):171–179. doi:10.1016/j.ajt.2022.10.009. https://pubmed.ncbi.nlm.nih.gov/36695685/

Transcript

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0:00.0	Behind the Knife, the Surgery Podcast, relevant and engaging content designed to help you dominate the day.
0:23.8	Welcome back to Behind the Knife. I'm Dr. Maddie Kluen, a general surgery resident at the University of Nebraska Medical Center.
0:28.5	I'm joined today by three phenomenal members of our transplant team, Dr. Evelyn Wowell.
0:32.9	I'm Evelyn. I'm the senior transplant fellow at UMC.
0:36.3	Dr. Jackie Dowell. Hi. I'm the abdominal transplant fellow at UNMC. Dr. Jackie Dow.
0:38.1	Hi.
0:41.2	I'm among the abdominal transplant surgeons at UNMC.
0:43.0	And Dr. Alex Mask.
0:46.0	I'm the kidney and thinkers transplant surgeon at UMC,
0:49.9	and I'm also a co-medical director of our local organ procurement organization.
0:55.1	We will discuss abdominal organ procurement in both brain dead and donation after circulatory death donors,
1:02.1	covering the warm and cold phases, donor hospital logistics, and considerations for pancreas, mobile, and multidastoral transplants,
1:06.9	all while emphasizing both the technical and non-technical aspects of procurement surgery.
1:11.7	This is such an important operation for both donors and recipients, but it can be surprisingly hard to find detailed practical teaching about it. We want to open up that black box. Before we dive
1:17.7	into the technique, can we zoom out for a second? What actually has to be in place before we even
1:22.8	go to the OR for an abdominal recovery? Yeah, thanks, Maddie. Have you to talk about kind of the
1:27.3	beginnings of organ procurement, which mainly involves organ procurement organization
1:31.2	before the surgeons actually step in. So there are a few things that must be in place
1:35.4	before our donor procurement can happen, and they don't involve transplant teams or surgeons.
1:39.6	So first, there's a medical determination that ongoing life-sustaining therapy is inappropriate.
1:45.1	So for patients who are brain dead, the ICU and neurology team must complete or document a formal brain death evaluation.
1:51.5	Once a patient is declared brain dead, the local organ procurement organization takes over the care of a donor until the organ procurement.
	...

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