CPT® Code 48550

1. Indications

The donor pancreatectomy procedure is indicated for the following conditions:

• Organ Transplantation This procedure is performed to procure the pancreas from a cadaveric donor for transplantation into a recipient who has a medical need for a pancreas, typically due to conditions such as type 1 diabetes or severe pancreatic dysfunction.

2. Procedure

The donor pancreatectomy involves several critical procedural steps to ensure the successful removal of the pancreas for transplantation:

• Step 1: Incision A large incision is made from the sternal notch to the pubis and across from the right to the left flank. This extensive incision provides the necessary access to both the thoracic and abdominal cavities, allowing the surgeon to visualize and manipulate the organs involved in the procedure.
• Step 2: Mobilization of Organs The pancreas is mobilized in conjunction with the liver. This step is crucial as it allows for the careful dissection of the surrounding structures and ensures that the organs can be removed together without damage.
• Step 3: Dissection of Vascular Structures The portal vein, hepatic artery, and bile duct are meticulously dissected to prepare for their ligation and removal. The gastro-duodenal artery is ligated to prevent blood flow, which is essential for the preservation of the pancreas during the harvesting process.
• Step 4: Identification of Arterial Origins The origin of the hepatic artery is dissected from the pancreas at the celiac axis, and the origin of the splenic artery is located. Additionally, the left gastric artery is ligated, and the origins of the celiac and superior mesenteric arteries are isolated at the aorta to facilitate the removal of the pancreas.
• Step 5: Mobilization of the Duodenum The duodenum is mobilized to allow for its division at the pylorus and the ligament of Treitz. This step is important for ensuring that the pancreas can be removed without obstruction.
• Step 6: Infusion of Preservative Solution As the thoracic organs are removed, the aorta and inferior mesenteric vein are infused with a preservative solution. This step is critical for maintaining the viability of the pancreas during the transplantation process.
• Step 7: Removal of the Liver The liver is removed first to provide better access to the pancreas. This sequence is important as it allows the surgeon to work more efficiently and reduces the risk of damaging the pancreas during its removal.
• Step 8: Division of the Superior Mesenteric Artery The superior mesenteric artery is divided at its origin, which is necessary for the complete removal of the pancreas.
• Step 9: Removal of the Pancreas Finally, the pancreas is removed, flushed again with preservative solution, and transferred to the back table for backbench preparation prior to transplantation. This final step ensures that the pancreas is adequately prepared for its new recipient.

3. Post-Procedure

Post-procedure care for the donor pancreatectomy involves monitoring the donor's condition, ensuring that all harvested organs are preserved properly, and preparing them for transplantation. The surgical site will be assessed for any signs of complications, and the preservation of the pancreas is critical to maintain its viability for the recipient. The surgical team must ensure that all necessary documentation is completed and that the organs are transported to the transplantation facility in a timely manner to optimize the chances of successful transplantation.