Background: In recent years, with the increment in the number of deceased donors in Japan, training young surgeons has been one of the major challenges. Unlike in Europe and the United States, there are still few opportunities to undergo organ procurement surgery under brain death in Japan. Therefore, because it is increasingly necessary for younger doctors to learn organ procurement, we use the Center for Development of Advanced Medical Technology (CDAMTec) at our institute to conduct simulations for deceased donor organ procurement using pigs. We look back on the deceased donor liver transplant experience in our department and introduce our surgically educational system for younger surgeons.
Methods:  Of the 425 liver transplantations performed at our hospital by December 2024, we examined the postoperative course of 15 deceased donor liver transplantations with liver removed by doctors who had undergone training with a simulation of organ procurement using pigs.
Results: The diseases for which deceased donor liver transplants were performed were acute liver failure (n=4), hyperammonemia due to ornithine carbamylase deficiency (n=3), graft dysfunction after living donor liver transplantation for biliary atresia (n=2), biliary cirrhosis due to intrahepatic bile duct paucity (n=1), Wilson's disease (n=1), biliary atresia (n=1), metabolic dysfunction associated steatohepatitis (n=1), primary sclerosing cholangitis (n=1), and glycogen storage disease (n=1). The grafts were lateral segment (n=3), right lobe with caudate lobe (n=1), and whole liver (n=11). When information about deceased donor candidates was obtained, younger surgeons who had been educated by training for organ procurement using pigs were able to perform the procurement surgery safely under the supervision of senior doctors. A mutual aid system was sometimes utilized. Fourteen recipients (93%) survived after deceased donor liver transplantation. We have also joined the organ procurements for recipients at other hospitals four times, either alone or as a joint team, and the procurement was completed without any problems. Not only operating room nurses but also anesthesiologists participate in the training using pigs to prepare for organ procurement surgery, making the simulation even more practical and comprehensive.
Conclusions: Simulation for deceased donor organ procurement by pigs, which can foster multidisciplinary team medical care, is a useful approach for the current increase in deceased donor organ procurement surgeries in Japan and is an effective tool for training young surgeons.