Piecemeal

"Procurement" is the proper terminology for the dissection of organs from an organ donor, but all too often, we refer to it as "harvesting." I don't know what the general public thinks about organ donations and the system of organ procurement, but it's a methodical, non-feeling process with very little emotion. We perform it with the same emotional load as your mechanic changing your alternator. Here's a sample play-by-play of how a harvest goes:

2:00 PM - Beeper goes off. I'm informed that we're to meet at the hospital to go get a liver at 4:30 PM. Location of the donor patient is not disclosed.

4:30 PM - Meet at the hospital, get in the minivan. En route to the airport, I'm told we're headed to Florida.

4:45 PM - Board a private jet. Find a seat, put on headphones, go to sleep.

6:20 PM - Land someplace in Florida. Get to hospital, greet surgical staff, greet the heart procurement team from Texas, see brain dead patient, scrub up, and get to work.

The Harvest - (takes about 2 hours)
+ Cut open donor from base of neck to groin.
+ Cut through breast bone with an air powered jig saw.
+ Initial look at donor's liver appears good, continue with harvest.
+ Identify liver vessels and biliary structures. Dissect out liver for retrieval.
+ Infuse ice cold organ preservation fluid into the liver.
+ Wait for heart team to get ready.
+ Clamp the vessels. Cut the inferior vena cava right below the heart. Suck out 5 liters from blood as patient exsanguinates. Pour ice into the body to cool the organs.
+Anesthesiologist turns off the machines and leaves the room. Patient is now organically dead.
+ Cut the aorta. Suck out remainder of blood.
+ Heart team removes the heart, puts it in ice, bags it up, and leaves.
+ We remove the liver, place it in ice. Identify kidneys, dissect out renal vessels and ureter, remove the kidney, place it in ice. Remove iliac vessels for possible vein grafts.
+ The patient has now been gutted. The body cavity is eerily empty, except for the gastrointestinal track.
+ Examine removed organs, classify them and measure them, bag them, place organs in ice chests.
+ Sew up donor patient.
+ Load up the Suburban and head back to the airport.

8:15 PM - Back in the plane. Eat take-out steaks from Ruth's Chris.

10:00 PM - Land in New Orleans, rush back to home hospital with the newly harvested liver.

10:20 PM - Begin liver transplant surgery on receipient.

2:00 AM - Finish transplant surgery. Escort patient to ICU. Sign off to surgical resident on call. Drive home.

2:30 AM - Shower, set alarm, check pager batteries, go to bed. Get ready for next day.

Rinse. Lather. Repeat.