Brain Death and Anesthesia Flashcards
UNOS and its responsibilities/role
united network for organ sharing
have to be a member of this organization to do anything or get reimbursement
develops policy, monitors/enforce processes of OPTN (organ procurement and transplantation network), maintain OPTN membership and review applications
allograft/homograft
tissue for transplant derived from a non twin donor of the same species. human to human like kidney donation
autograft
tissue forr transplant derived from the recipient ex)burn patient donating own skin
orthotopic
implanting organ in anatomic position after native organ is removed
heterotopic
implanting an organ leaving the native organ in place (like kidneys)
xenograft/heterograft
tissue grafted from one species to another ex) pig valves, ex)baboon heart transplanted into child (who is v dead)
Major histocompatibility complex (MHC) antigens
cell surface glycoproteins that establish immunologic identity.
MHC antigens classes
class 1: human leukocyte antigen (HLA) a-b-c (classic transplant antigens) class 2: HLA DR-DQ-DP (on activated T cells) increase in class II HLA usually increases PRA and makes matching more difficult
major blood group antigens
ABO potent transplant antigens. usually tested for kidney, pancreas, and lungs but sometimes have to test post lung transplant
describe varying degrees of HLA tissue typing
kidney: ABO and HLA matching, t cell cost match and PRA (panel reactive antibody profile)
heart, liver- ABO and other factors such as size/urgency
types of organ donors
cadaveric (deceased): donation after brain death (DBD)
non heart beating organ donor; donation after cardiac death (DCD)
living donor: kidney paired donation
deceased organ donors: 4 criteria to meet and something to consider
crate: previously healthy, brain death established, negative for extra cranial malignancy, absence of untreatable infection. consider donor mechanism of injury (usually violent)
definition of brain death
irreversible cessation of all functions of the brain including the brainstem.
for determination of brain death, you have to rule out these reasons for reversible cerebral dysfunction
hypothermia hypotension metabolic/endocrine instability drug overdose (look at chart in miller)
when doing determination of brain death examination, explain the criteria
comatose (unresponsive to verbal stimuli) absence of cerebral cortical function (non responsive to painful stimulus. absence of spontaneous movement) loss of brain stem function (absence of reflexes) supporting studies (EEG, cerebral blood flow studies) neurological absence of brainstem function
when doing determination of brain death examination, describe how to assess for neurological absence of brain stem function
pupillary response to light
corneal reflex
oculocephalic reflex absent (dolls eye response)
oculovestibular reflex absent (cold caloric test)
gag and cough reglex
absent respiratory reflex (apnea test)
determination of brain death: how to perform the apnea test
100% FiO2 for 10 minutes
normalized PaCO2 (confirmed by ABG, T piece for 7-10 minutes, repeat ABG)
PaCO2 >60mmHg during test
absence spontaneous ventilation
who cannot declare brain death
transplant team
DCD s/p cardiac arrest: death anticipated within
1-2 hours after life support is withdrawn
warm ischemia time can be _______ v _________
controlled (ICU, decision to take off life support) versus uncontrolled
living organ donors: kidney and advantages
decreased cole ischemic time
less time on waiting list
kidney living organ donors: how is the surgery performed
laparoscopic or open
kidney living organ donors: selection of kidney from living donor
usually left side because it is easily accessible and longer vasculature
kidney living organ donors: anesthetic
GETT standard monitors, maintain UOP (mannitol, lasix 30m prior to removal), 10-20ml/kg/h NS
