Recently a brain dead 49 year old donated his kidneys that could end up saving two precious lives. The supreme gesture should be saluted like every such noble gesture for community benefit. This donor had an anatomical anomaly called situs inversus totalis.
Situs inversus is an anomaly where the organs are placed in mirror image position from their typical orientation (situs solitus). Situs inversus may occur in various levels with total inversion being called situs inversus totalis the more common form is right sided heart (dextrocardia) with situs solitus.
Situs inversus totalis is usually a benign condition though about 20% are associated with Kartegener's syndrome ( infertility, respiratory disease and situs inversus).
Situs inversus being rare causes an unfamiliar surgical environment for the surgeons who may have never encountered such anatomy during their training. When an deceased organ donor has situs inversus it may pose minor problems and the surgeon has to constantly be aware of the altered anatomy to avoid inadvertent injury to vital structures.
When a living donor has situs inversus it can be problematic to position the graft particularly the right lobe which has to be placed in the left side of recipient. This can lead to angulation of the graft that can compromise its outflow by causing kinking. There are few such reports in literature requiring innovative methods like placement of tissue expanders to prevent angulation.
Cadaveric whole liver may need to be rotated 180 degrees to facilitate tension free vascular anastomosis.
Surgeons in the history of liver transplantation have had to innovate frequently to successfully use scarce donor organs successfully.
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