Anesthesia for the organ donor Flashcards
The Organ Procurement and Tranpslantation Network facilitates
organ matching/allocation process
collects & manages data about organ donation & transplantation
professional and public education
United Network for organ sharing is responsible for
developing policy
monitoring/enforcing processes of OPTN
maintain OPTN membership & review applications
Describe allograft/homograft.
tissue for transplant derived from a non-twin donor of the same species (i.e. human to human)
Describe autograft.
tissue for transplant derived from the recipient
ex. burn patient
Describe orthotopic.
implanting an organ in the anatomic position after the native organ is removed
Describe heterotopic
implanting an organ leaving the native organ in place
ex. kidney
Describe xenograft/heterograft.
tissue grafted from one species to another
ex. pig valves for valve replacement
Describe immunology as it relates to organ transplant
major histocompatibilty complex antigens
major blood group antigens
varying degrees of HLA tissue type
Major histocompatibility complex antigens (MHC) are
cell surface glycoproteins that establish immunologic identity
- Class 1- Human leukocyte antigen (HLA) A-B-C (classic transplant antigens)
- Class II- HLA Dr-DQ-DP (on activated T cells)
Major blood group antigens include
A-B-O potent transplant antigens
When preparing for kidney transplant, the following immunology is tested
ABO & HLA matching, T-cell cross match & PRA (panel reactive antibody profile)
When preparing for heart & liver transplant, the following immunology is tested
ABO & other factors such as size
tends to have higher urgency d/t less warm time so HLA is often done after transplant
Types of organ donors include
cadaveric: donation after brain death (DBD)
non-heart beating organ donor; donation after cardiac death (DCD)
living donor- kidney paired donation
Considerations for donation after brain death include
previously healthy brain death established negative for extracranial malignancy absence of untreatable infection donor mechanism of injury- typically trauma which involves lots of ethical, religious, and social factors
When determining brain death, reversible cerebral dysfunction must be ruled out including
hypothermia
hypotension
metabolic/endocrine instability
drug overdose- like barbiturate overdose (causes isoelectric EEG)
must wait 12-24 hours after ruling these out to proceed with brain death workup
Determination of brain death criteria include
comatose- unresponsive to verbal stimuli
loss of brain stem function- reflexes
supporting studies- EEG, cerebral flow studies
absence of cerebral cortical function- non-responsive to painful stimulus, absence of spontaneous movement
Neurological absence of brain stem function includes
pupillary response to light
corneal reflex
oculocephalic reflex absent- doll’s eye response
oculovestibular reflex absent- “Cold caloric test”
gag & cough reflex
absent respiratory reflex (apnea test)
Describe the doll’s eye response.
normal for eyes to move opposite way if fixed when head is rotated so with doll’s eye they’ll remain fixed
Describe the cold caloric test.
irrigating auditory canal with cold fluid & have nystagmus and they deviate towards ear that is being stimulated (normal); remain fixed if they do not
Describe the absent respiratory reflex.
100% fio2 for 10 minutes to normalize PaO2 then for 7-10 minute put them on a T piece and observe to see no respiratory attempt & a PaCO2 >60 is positive
Describe the apnea test.
100% fiO2 for 10 minutes
normalized PaCO2- confirmed by ABG, T-piece 7-10 minutes, repeat ABG
PaCO2 >60 mmHg
absence of spontaneous ventilation
Describe non-heart beating organ donation.
-may still have brainstem activity intact but decision is made to remove patient from life support
S/P cardiac arrest- death anticipated within 1-2 hrs after life support is withdrawn
warm ischemia time- controlled vs. uncontrolled
The transplant team cannot be a part of
the decision making process nor can declare brain death
Describe living organ donors for kidneys
.donor characteristics- donors are healthy and generally hemodynamically stable
