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CPH/PPD > Mark Nelligan Generic LOBs > Flashcards

Mark Nelligan Generic LOBs Flashcards

1
Q

Organs that are commonly donated

A

Kidneys

Eyes (cornea)

Heart

Lungs

Liver

Pancreas

Skin

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2
Q

Solutions for organ shortages?

A
  1. Opt-in system-People must actively join register
  2. Opt-out system (“presumed consent”) -
    People must actively get removed from register
  3. Mandated choice -People are forced to make a decision
  4. Mandatory (deceased or live) donation - Everyone must donate organs
  5. Payments - Establish a free/regulated market in organ sales
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3
Q

Reasons for organ shortage?

A

Family consent, and negative
attitude contribute towards
organ shortage.

This could be due to the
following reasons -
1. Religion
2 Fear, ignorance and
misunderstanding
3. Legal aspects
4. Media reports on scandals
involving organ rackets
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4
Q

How to improve organ donation

A
  • Supporting organization for
    networking and registry
    maintenance
  • Effective use of technology to
    facilitate organ donation
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5
Q

Contraindications to renal transplant

A

ABO incompatibility (relative)

Cytoxic antibodies against HLA antigens of donor.

Recent or metastatic malignancy.

Active infection.

HIV positivity ( relative)

Severe extrarenal disease (cardiac, pulmonary, hepatic).

Active vasculitis or glomeulonephritis.

Uncorrectable lower urinary tract disease.

Noncompliance.

Psychiatric illness including alcoholism and drug addiction.

Morbid obesity.

Age > 70 years.

Primary oxalosis.

Persistent coagulation disorder.

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6
Q

Comparison of survival rates in dialysis and transplant

A

Annual mortality rates for patients under dialysis
range from 21%-25%, but <8% with cadaveric and
<4% with living-related transplant recipients.

Healthier patients generally are selected for
transplantation.

The benefit of transplantation is most notable in
young people and in those with diabetes mellitus.

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7
Q

Criteria for living donor selection

A

Highly motivated.

ABO blood group-compatible.

HLA-identical or haploidentical
with negative cross-match.

Excellent medical condition with
normal renal function.

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8
Q

CRITERIA FOR CADAVER

DONOR SELECTION

A

Irreversible brain damage.

Normal renal function appropriate for age.

No evidence of preexisting renal disease.

No evidence of transmissible diseases.

ABO blood group-compatible.

Negative cross-match.

Best HLA match possible, particularly at the
DR and B loci.

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9
Q

Principles Involved In evaluating A

Prospective Living Kidney Donor

A

Whether there is a medical condition that
will put donor at increased risk for
complications for general anaesthesia or
surgery.

Whether the removal of one kidney will
increase the donor’s risk for developing
renal insufficiency.

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10
Q

Evaluation of kidney Fx in potential kidney donor

A

Serum creatinine.

Creatinine clearance.

Radionuclide glomerular filtration rate.

Urine analysis.

Urine Culture.

GFR > 70 ml/min.

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11
Q

Medical Conditions that exclude living kidney donation

A

Renal parenchymal disease.

Conditions that may predispose to renal disease

  • History of stone disease
  • History of frequent UTI
  • Hypertension
  • Diabetes Mellitus

Conditions that increase the risks of anaesthesia
and surgery.

Recent malignancy.

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12
Q

Does donation of kidney pose LT risk for donor

A
  • increase GFR in remaining kidney so slight risk of proteinuria and HTN
  • Metaanalysis confirmed >20yr safety after kidney donation
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13
Q

Components of matching between recipient and donor

A

A- Tissue typing
Determined by 6 antigens located on cell surface
encoded for by the HLA gene located on the short
arm of chromosome 6.
- Class I antigens (HLA-A and HLA-B) are expressed
on the surface of most nucleated cells.
- Class II antigen (HLA-DR) are expressed on surface
of APC and activated lymphocytes.
- These 6 antigens are referred to as major transplant
antigens.
- The match between donor and recipient can range
from 0 to six.

B- Cross matching

  • A laboratory test that determines whether a potential
    transplant recipient has preformed antibodies against the HLA
    antigens of the potential donor. (Donor Lymphocytes +
    Recipient Serum)
  • A Final CM is mandatory

C- Compatible ABO blood group.

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14
Q

Factors affecting longevity of renal allograft

A

Age

HLA matching

Delayed graft function

Ischemia time.

Number of acute rejection
episodes.

Native kidney disease.

Ethnicity.

Others

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15
Q

LT Complications of allograft

A
  1. Chronic rejecction

2, Death with fx graft

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16
Q

Risks associated with chronic immunosuppression

A

1- Malignancy

2- Infection

3- Side effects of different drugs
(steroids, CsA, tacrolimus, MMF, …..)

17
Q

Living donor steps

A
  1. Meeting of potential recipient and donor w/ coordinator
  2. Initial blood tests
  3. Immunological tests
  4. Meeting w/ transplant nephrologist
  5. Meeting with transplant surgeon
  6. Discussion of case at weekly meeting and completion of examinations
18
Q

Criteria and point allocation for

candidate selection from the waiting list

A

Time on the Waiting List

HLA typing matching

Recipient age

Difference in age between donor and
recipient

ABO blood compatibility

Extra points for children and sensitized
patients

19
Q

What is paired donation

A

Potential donor A and potential recipient B are in a relationship (relation, friend or
partner) but are not genetically compatible. Potential donor C and potential
recipient D are in the same position. A is compatible with D and C is compatible
with B. Thus A gives to D and C gives to B

20
Q

wHAT IS POOLED DONATION

A

Like paired but more than two pairs involved in swap

21
Q

What is Non-directed donation v directed donation

A

Person offers to donate an organ to anyone who might benefit v person offers to donate an
organ to a specific person/group.

22
Q

What is domino organ donation

A

When an organ is removed for the primary purpose of that person’s medical treatment, but
then used for transplant into another person

23
Q

Is it unethical for a doctor to encourage pts. to be living donor

A

YES - it is unethical for a doctor to encourage his/her pt.

1.‘First do no harm’ primum nil nocere

  1. ‘Doctors have a secondary dutyto promote organ donation and transplantation as one way of promoting public health. But this secondary duty should not supersede
    their primary duty
  2. Act in best interests of patients and respect their autonomy
    Doctor asking may be seen as coercion due to the power imbalance in doctor/pt. relationship…… valid consent consequences may
    ensue

NO - it is not unethical …..

A good thing? A noble thing? Offering a gift - of life - Latin – ‘Donum’ -
gift & ‘Dare’ to give

‘If something is not wrong to do but is actually a good thing, then it
cannot be wrong to encourage the doing of it’

Demonstrates solidarity between humans

24
Q

Who regulates organ transplants

A

NHS Blood and Transplant (NHSBT) : Special Health Authority SPA which is responsible for: efficient supply of
blood, organs and associated services to the NHS

Human Tissue Act 2004 : provides the legal framework for organ donation

The Human Tissue Authority:
aims to ensure that human tissue is used safely, ethically, and with proper
consent.

25
Q

What does the human tissue act 2004 say about transplants?

A
  1. Makes consent the most important principle for
    the lawful retention and use of human tissue
  2. Established the Human Tissue Authority
  3. Makes it an offence to transplant organs unless the
    regulations of the Act are adhered to.
  4. Makes it an offence to be involved in the sale of
    organs in any way

Living donations:

  1. HTA to approve all (related or not) including paired/pooled and altruistic
    (directed or not)
  2. HTA Independent Assessor (IA) to meet donors/recipients and to report to HTA.
  3. HTA Panel must consider special cases (e.g. children).

Deceased donation:

  1. No need for HTA approval.
  2. If patient has consented then consent is sufficient.
  3. If patient does NOT consent then no transplant
    can go ahead
  4. If patient has nominated a person to make the
    decision then the nominee can give proxy consent
  5. If patient has not expressed any wishes either way
    people in ‘Qualifying Relationship’ can consent
26
Q

Qualifying relationships

A

In the following order:
a) spouse or partner (inc. civil or same sex partner)

b) parent or child
c) brother or sister
d) grandparent or grandchild
e) niece or nephew
f) stepfather or stepmother
g) half-brother or half-sister and
h) friend of long standing.

27
Q

When can you harvest an organ

A

Brain stem death BSD (Heart beating
donation)

  • Donation after Circulatory Death DCD
28
Q

Significance of brain death

A

Acceptance of brain death has done much to facilitate transplantation

Prior to acceptance of brain death, patients not dead until breathing &
circulation stopped

Death must be clearly pronounced, entered in record before transplantation is
discussed

Some have claimed that brain death is “too convenient” a definition of death

29
Q

Donation after circulatory death

A
  • Organ donation that takes place following diagnosis of death by
    cardio-respiratory criteria, Code of Practice for Diagnosis and Confirmation of Death.
  • Form of donation known as non-heart beating donation (NHBD),
    and donation after cardiac death (also shortened to DCD) in recent
    times.
  • Donation after circulatory death may be controlled or
    uncontrolled.

CPH/PPD (8 decks)

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