Surgery: When a suitable donor intestine becomes available, the patient is prepared for surgery. Patients with a history of multiple previous abdominal surgeries, fistulae, and adhesions, make the dissection phase of the operation very complex. If there is a need to remove some part of the remaining intestine or a tumor, it may be a very lengthy procedure, often lasting several hours. The major blood vessels of the abdomen called the Aorta and Inferior Vena Cava (IVC) are prepared for supplying blood to the intestine. For a multi-visceral transplant, the patient’s liver also is removed, which is not only more time consuming, but may be associated with significant bleeding.

Donor surgery involves removing the intestine (for intestine transplant alone) with other organs (for multi-visceral transplant) from the donor and preserving them in ice-cold preservative solution. The preserved graft is pale and does not exhibit the typical movement (peristalsis). The graft is prepared for transplant during bench surgery by removing excessive tissue and preparing the blood vessels. Once the intestine / multi-visceral graft is ready, it is taken to the recipient’s operating room (OR) for implantation. The first step is to establish blood flow through the graft by joining the donor graft’s artery and veins to the recipients (the surgical connection/joint is called anastomosis). Once blood flows through the new intestine is established, it regains its pink color and peristalsis. The ends of the donor graft’s intestine are then joined with the recipient’s intestine.