01 Evaluation for Transplantation Flashcards
The evaluation process is important to…
determine whether to proceed with transplant
Informed consent is a process a patient goes through to…
gather information or education in order to be prepared for decision making for medical care and treatment
A Donation after Circulatory Death (DCD) Donor requires that the patient is informed and …
documented in the EMR.
Informed Consent under the 2020 PHS rules includes a requirement to document that you have informed the recipient of the presence of…
Risk Criteria
For KDPI > 85%, the transplant program must obtain…
written, informed consent.
The Role of the Transplant Coordinator in the Evaluation Process includes these 3 practices…
- Education regarding evaluation process
- Education regarding listing process
- Answer patient and family questions
The Role of the Financial Coordinator in the evaluation process is to…
determine if the candidate has sufficient access to financial resources to ensure a positive outcome following transplantation
The Role of the Nutritionist in the evaluation process is to…
help the candidate follow a healthy diet: malnutrition can affect post-transplant outcomes
The Role of the Pharmacist in the evaluation process is to…
assure the candidate understands complex post-transplant medication regimen including common side effects
3 Purposes of the Psychosocial Evaluation is to…
- assess a candidate’s appropriateness for transplant
- ability to comply with complex post-operative regimen
- current or past history of substance abuse
2 Roles of the Social Worker in the evaluation process is to…
- assess patient and family support system
- identify need for potential resources
3 Purposes of the Surgical Evaluation is to…
- determine if transplantation is the appropriate procedure for the candidate
- determine if the surgery is feasible
- determine if the surgery can be done safely
Potential additional consultations may include…
cardiac, pulmonary, infection disease, etc. based on examinations and medical history
3 General Absolute Contraindications to Transplant include:
- Active or recent malignancy
- Active Substance use or abuse
- ACTIVE infection
3 Relative Contraindications to Transplant may include:
- Lack of financial resources
- Lack of psychosocial support
- History of non-adherence with medical regimens
3 Requirements of CMS Conditions of Participation include…
- Each recipient receives care from an experienced multi-disciplinary team
- Each transplant center is providing quality care with expected outcomes
- Each patient receives education and provides informed consent
The Scientific Registry of Transplant Recipients (SRTR) provides…
data on transplant center’s graft survival by organ
3 types potential donors include…
- Living Donors
- Deceased Donors including: PHS increased risk donors
- Donation after Circulatory Death (DCD) Donors
2 factors with respect to communication of donor information to the recipient…
- do not share donor information
- communication is via OPO and Transplant Center
Medicare Insurance part ____ for immunosuppression medications covers _____%
- Medicare Part B
- Covers 80% of cost
A History and Physical (H&P) includes these 4 elements…
- complete medical history of all organ systems
- surgical history
- infectious history
- family history
General Laboratory Testing includes these 7 elements…
- Basic metabolic panel
- Hepatic panel
- Lipid profile
- Complete blood count
- Thyroid panel
- Urinalysis
- ABO Coagulation
PRA is determined by…
testing the serum of prospective recipient against a panel of lymphocytes for the presence of circulating antibodies reactive against HLA antigens
PRA is expressed as a…
percentage between 0 and 100%
PRA represents…
the % of the population against which the recipient will have pre-formed antibodies
The higher the PRA %, the …
harder it is to find a good match for transplant
3 aspects of Human Leukocyte Antigen (HLA) is…
- assessed pre-operatively in the allocation of kidneys
- used in certain organs to predict rejection
- signifies that rejection may happen when the recipient has antibodies to the donor’s antigens
Infection screening determines…
the recipient’s suitability for transplant and post-transplant infection risk
7 Infections screened for includes…
Screening for ACTIVE infections:
- HIV
- CMV
- EBV
- Herpes
- RPR
- Toxoplasma
- TB
Hepatitis screening…
determines previous exposure and need for further testing or treatment
screening is for ACTIVE infections: Hepatitis A, B, C
Cancer screening…
- Transplant recipients are at increased risk of developing cancer due to medications
- AFP, Cervical, Prostate
CBC Values: White Blood Cells (WBC)
- Number of infection-fighting cells
- Normal Value: 5-10
- Units: x1000/mm3
CBC Values: Red Blood Cells (RBC)
- Carry oxygen and carbon dioxide
- Normal Value: 4.2 - 6.1
- Units: x 1,000,000/mm3
CBC Values: Hgb (hemoglobin)
- Measure of RBC
- Normal Value: 12-18
- Units: g/dL
CBC Values: Hct (hematocrit)
- Percentage of blood made up of RBC’s
- Normal Value: 37-52
- Units: %
CBC Values: Plt (platelets)
- Number of platelets shows risk of bleeding
- Normal Value: 150-450
- Units: x 1,000/mm3
Coagulation values…
calculate the role of proteins necessary for blood clot formation
Coagulation Values: Platelets
140,000-450,000/ml
Coagulation Values: PT (prothrombin time)
10-14 seconds
Coagulation Values: PTT (partial thromboplastin time)
32-45 seconds
Coagulation Values: INR (international normalized ratio) for patients on anti-coagulation therapy
2.0-3.5
Coagulation Values: INR (international normalized ratio) for healthy patients
<1.1
Lab Value: BUN
7-20 mg/dL
Lab Value: Creatinine
0.6-1.2 mg/dL
Lab Value: AST
10-40 units per liter
Lab Value: ALT
7-45 units per liter
Lab Value: Total bilirubin
0.3 to 1.2 milligrams per deciliter
Lab Value: Amylase
40-140 U/L
Lab Value: Lipase
0-160 U/L
Lab Value: c-peptide
0.5 to 2ng/ml
Lab Value: PSA
4.0 nanograms per milliliter (ng/ml) of blood
- men 50s or younger should be below 2.5
- men older than 50’s slightly higher
5 Potential short and long-term complications to discuss with candidates includes…
- infection
- rejection
- medication side-effects
- chronic illness diagnoses
- requires frequent and life-long monitoring
4 Roles of Transplant Coordinator: Suitability Assessment includes…
- Identify multi-disciplinary team recommendations
- Present findings to team
- Communicate findings to candidate
- Facilitate any additional procedures/protocols/health maintenance
The decision regarding listing must…
- be documented per UNOS:
The types of decisions regarding listing include…
*List as active or inactive
* Defer pending additional evaluation
* Not a candidate
6 patient reminders during Waitlist Education includes…
- Staying healthy
- Routine office visits
- Constant communication
- Distance travel
- Maintain insurance/notify of changes
- Organ specific labs
Role of Transplant Coordinator: Patient/Family Education includes these 7 actions…
- Discuss ability to resume relatively normal life-style
- Review indications/contraindications to transplant
- Review risks for undergoing transplant surgery
- Review comprehensive medical/surgical/psychosocial transplant assessment
- Discuss likelihood of an improved life expectancy
- Review there are no other medical or surgical options
- Obtain informed consent for evaluation process/document in EHR
