Heart & Lung Transplant Rehab. Flashcards
What is most transplanted organ?
Kidney.
Followed by liver
What does the OPO (organ procurement organization) do?
identifies, evaluates, and maintains donor
-including obtaining consent.
Can the physician of the donor or the physician that pronounces death be involved in the transplant?
NO
How long does transplant center have to decide after organ is offered?
1 hr
how many hrs are there between organ harvesting and transplantation?
6-8 hrs
What are the cardinal signs of brain death that a donor must show
Coma/unresponsive
- absnece of motor responses to pain
- absence of brain stem reflexes
- apnea
what is the transplant process ?
- Deceased donor
- OPO
- UNOS (United network of organ sharing - computer system)
- transplant center
- candidates
Organs must be matched on?
- tissue type
- blood type
- length of time on waiting list
- immune status/antigens
- distance between recipient and donor
- degree of medical urgency
What are the 3 ethical considerations? and what do they involve?
Which is prioritized?
- Utility
- maximize benefit to all
- consider survival and QOL - Justice/equity** (prioritized)
- fair distribution
- sicker 1st - respect for persons
- right not to donate
- transparency
Heart transplant donor criteria
-normal EKG
No HIV or hepatitis
-brain death declare
-age
Heart transplant recipient criteria
- terminal heart disease
- no renal/hepatic dysfunction
- no acute infections
- no recurrent pulmonary infections
- psychosocial stability
- no alcohol, drug, tobacco use
Pre transplant rehab?
maximize candidates strength and endurance to activity
-closely monitor HR, BP, 02 st, dyspnea
Early complications Post transplant
- donor organ dysfunction
- acute rejection
- retail failure
- arrhythmia
- bleeding
- infection due to immunosuppression
- denervated heart physiology
What occurs in Acute rejection?
- all recipients reject organ to some degree
1. organ function starts to decrease
2. general discomfort, uneasiness, ill feeling
3. pain/swelling in organ area
4. fever/flu like symptoms
What is infection due to immunosuppression?
- caregivers must wear masks
- must take anti rejection meds for life
- Glucocorticoids (prednisone) suppress body’s natural immune system
- steriod myopathy: damdage to mm tissue - weakness
What percentage of heart transplants is due to coronary artery disease/ischemic heart disease?
44.8%
Orthotopic heart transplants
patient’s heart replaced by donor’s heart
Heterotopic heart transplants
donor’s heart placed next to recipient’s heart
Chronic complications post-transplant
a. prone to infection due to immunosuppression
b. accelerated CAD
c. chronic rejection (greatest risk within first year)
d. HTN
e. malignancy
Pre-transplantation rehab maximizes what?
cardiac rehab maximizes candidate’s strength & endurance
Post-transplantation rehab focuses on what?
Focus on functional mobility:
- sternal precautions
- phase 1 cardiac rehab
- abnormal HR responses
Special considerations with exercise?
- denervation: loss of vagal tone, lack of SNS stimulation
- patient may not have chest pain during exercise
- patient will have higher resting HR which will only increase with exertion (>100 bom)
- altered baroreceptor response: HR increases slowly with exercise and then remains elevated for increased time post-exercise
- signals from aortic baroreceptors normally travel thru vagus nerve (upon sitting/standing, BP will drop –> without baroreceptors there will be a poor readjustment to normal BP
Ventricular assisted device (VAD) is used in what kind of patients?
patients with non-reversible left ventricular failure at imminent risk for death
Function of VAD?
- a mechanical pump used to support heart function and blood flow in people with weak or failing hearts.
- 2 chamber unit made of titanium: blood chamber and chamber for electric motor
- The device is implanted in the left upper quadrant of the abdomen and pumps blood from the lower chambers of the heart to the rest of the body.
- bridges the gap between terminal heart disease & heart transplant
