- Connect the donor liver to the recipient IVC. This can be done two ways: Remove a length of recipient IVC (placing a shunt from the infrahepatic IVC to the subclavian vein, if necessary) and graft in the IVC on the donor liver, making two anastamoses-infrahepatically and suprahepatically. Alternatively, perform a "piggyback" transplant, where the donor IVC is closed at the top and bottom, and opened on its posterior surface. Fillet off the recipient's liver from the IVC, and anastomose the two IVCs together.
- Join hepatic portal veins
- Join hepatic arteries (begin reperfusion slowly, to avoid a bolus of potassium being washed out and into the heart) The ECG will show transient hyperkalaemic changes - T waves increasing in size.
- Remove the gallbladder (it does not function well after transplantation) and anastomose the donor common hepatic duct with the recipient common bile duct
- Close up