CPT® Code 47133

1. Indications

The donor hepatectomy procedure is indicated for the procurement of a liver from a cadaver donor for transplantation purposes. This procedure is typically performed when there is a need for a liver transplant due to conditions such as end-stage liver disease, acute liver failure, or other liver-related pathologies that necessitate the replacement of a diseased liver with a healthy one from a deceased donor.

• End-stage liver disease A condition where the liver has significantly deteriorated and is no longer able to function effectively, often requiring transplantation.
• Acute liver failure A rapid loss of liver function that can occur due to various causes, including viral hepatitis, drug toxicity, or metabolic disorders, necessitating urgent transplantation.
• Other liver-related pathologies Various other conditions affecting liver health that may lead to the need for a transplant, including cirrhosis, liver tumors, or congenital liver diseases.

2. Procedure

The donor hepatectomy procedure involves several critical steps to ensure the successful removal of the liver from the cadaver donor. The first step is to make a midline incision from the substernal notch to the pubis, which provides access to the abdominal cavity. Following the incision, the round and falciform ligaments are divided to free the liver from its attachments. The liver is then carefully exposed and inspected for any abnormalities. The gastrohepatic ligament is examined, and the left hepatic artery is identified and preserved to maintain blood supply to the liver. Next, the common hepatic and right hepatic arteries are also identified and preserved. The common bile duct is divided to facilitate the removal of the liver, and the gallbladder is flushed with normal saline to prepare it for preservation. Subsequently, the distal aorta and inferior mesenteric vein are isolated to control blood flow during the procedure. The right gastric artery and gastroduodenal arteries are ligated to prevent bleeding. The main hepatic artery is dissected back to the aorta, ensuring that the blood supply to the liver is adequately managed. The splenic and left gastric arteries are located and ligated unless an anatomic variance necessitates a modified approach. The portal vein is then isolated and dissected back to the superior mesenteric and splenic veins, completing the vascular dissection. Once all necessary structures are identified and ligated, the aorta is cross-clamped below the diaphragm to facilitate the next step. Preservation solution is instilled into the aortic and portal veins to ensure the liver remains viable during transport. Finally, the liver is removed from the donor's body and packed in ice to maintain its integrity until it can be transplanted into a recipient.

3. Post-Procedure

After the donor hepatectomy is completed, the liver is carefully packed in ice to preserve its function and viability for transplantation. The organ must be transported promptly to the transplant center where it will be implanted into the recipient. It is crucial to monitor the preservation conditions during transport to ensure the liver remains in optimal condition. The surgical team may also need to document the procedure thoroughly, including the time of removal and the condition of the liver, to provide essential information for the transplant team. Additionally, any complications or anomalies encountered during the procedure should be recorded for future reference and to ensure compliance with transplant protocols.