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AS - N934 Advanced Principles II > Organ Donation > Flashcards

Organ Donation Flashcards

1
Q

DBD

A

Donation after brain death

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2
Q

DCD

A

Donation after cardiac death
Non-beating donor heart
Status post cardiac death
Death anticipated w/in 1-2hrs after life support withdrawn

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3
Q

What is the most commonly performed transplant?

A

Kidney

Followed by liver, heart, & lungs

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4
Q

Allograft/Homograft

A

Tissue for transplant derived from non-twin donor same species
Human → human

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5
Q

Autograft

A

Tissue for transplant derived from the recipient (self)

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6
Q

Orthotopic

A

Implanting an organ in the anatomic position after the native organ removed

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7
Q

Heterotopic

A

Implanting an organ leaving the native organ in place

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8
Q

Xenograft/Heterograft

A

Tissue grafted from one species to another

Porcine valves

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9
Q

Major Histocompatibility Complex (MHC) Antigens

A

Cell surface glycoproteins that establish immunologic identify

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10
Q

Class I HLA

A

Human leukocyte antigen

Classic transplant antigens

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11
Q

Class II HLA

A

More difficult to match

Present on activated T cells

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12
Q

Reversible Cerebral Dysfunction

A

Hypothermia
Hypotension
Metabolic/endocrine instability
Drug overdose

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13
Q

Brain Death

A

Comatose - unresponsive to stimuli
Absence cerebral cortical function - non-responsive to painful stimulus & absence spontaneous movement
Loss brain stem function - no reflexes present
Supporting studies - EEG & cerebral flow

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14
Q

Brain Stem Function

A

No pupillary response to light (fixed & dilated)
Corneal reflex absent
Oculocephalic reflex absent
Oculovestibular reflex absent
No cough or gag reflex
Apnea test - absence spontaneous ventilation

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15
Q

Oculocephalic Reflex

A

Doll’s eye response
Eye fixed when head rotated indicates the brain stem not intact
Normal response = rotate head to L eyes more to the R

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16
Q

Oculovestibular Reflex

A

Cold caloric test
Irrigate auditory canal w/ ice water
Normal response = nystagmus then eyes deviate toward the stimulated ear

17
Q

Corneal Reflex

A

Blink or eyelid reflex
Orbicularis oculi contraction in response to light cornea touch
Involuntary blinking elicited by cornea stimulation

18
Q

Apnea Test

A 
Pre-oxygenate 100% FiO2 10min
Normalize PaCO2
Place T-piece 7-10min & assess respiratory effort
Repeat ABG
PaCO2 > 60mmHg
Absence any spontaneous ventilation

Unable to complete apnea test in sick or critically ill patients w/ lung disease
Other diagnostics necessary

19
Q

Organ Preservation Time

Heart & Lungs

A

4-6 hours

20
Q

Organ Preservation Time

Liver

A

8-12 hours

Up to 24 hours

21
Q

Organ Preservation Time

Pancreas

A

12-18 hours

22
Q

Organ Preservation Time

Kidney

A

24-36 hours

23
Q

Living Kidney Donors

A

Advantages as donors are generally healthy ASA 1 or 2
↓cold ischemic time
Less time on waiting list
Open or laparoscopic
Typically L kidney chosen d/t more readily accessible & longer vascular access
Maintain UOP w/ Mannitol or Lasix
Heparin prior to clamp (may need to reverse w/ Protamine)

24
Q

Living Liver Donors

A

Partial liver hepatectomy
Adult R side 5-8 segments
Pediatric 2 or 3rd lobes L side (smaller therefore easier surgical technique to retrieve)
Donor liver regenerates 1-6mos back to original size

25
Q

Living Lung Donors

A 
Not common
Cystic fibrosis
Immediate family member
Size & match
Multi-donor resection
↑donor morbidity
26
Q

Organ Preservation

A

Hypothermia ↓metabolism
Preservation solutions - maintain cellular integrity, prevent swelling or metabolite build-up, provide an energy source
Ex vivo - rapid cooling 4°C
Organs removed in susceptibility to ischemia order
Heart → lungs → liver → kidney
Implantation & reperfusion

27
Q

Donor Anesthesia

A 
Goal = preserve organ perfusion & oxygenation
MAP 60-100
UOP 0.5-3mL/kg/hr
Hgb > 10g/dL
Glucose 120-180
CVP 5-10mmHg
FiO2 < 40%
PEEP < 10
SaO2 > 95%
PaO2 > 100mmHg
Temp > 35°C
28
Q

Donor

Anesthetic Management

A 
Fluid 1st crystalloid or colloid
Vasopressors - Dopamine, Vasopressin, Dobutamine, Epinephrine
Bradycardia resistant to Atropine
- Isoproterenol (direct acting)
Diabetes insipidus
- Vasopressin or DDAVP
- Monitor electrolytes
- UOP replacement
29
Q

Donor Anesthesia

Monitoring & Medications

A 
A-line
CVP or Swan
Pressors
Sodium nitroprusside, Nitroglycerin, β blocker
PRBCs/FFP
Heparin
Mannitol or Lasix
Methylprednisolone
PGE1
Long-acting non-depolarizing muscle relaxant
30
Q

Donor Anesthesia

Special Considerations

A

Confirm ETT placement
Midline incision from neck to pubis
Know organs to be retrieved
Sternal saw → drop lungs
Organs mobilized & dissected
Aorta cross-clamped & ventilator turned off
Heart/lung procurement → continue to manually ventilate at 4bpm until told to stop by surgical team

31
Q

ESRD Etiology

A 
Diabetes 30-40%
Glomerulonephritis
Polycystic kidney disease
Hypertensive kidney disease
Chronic pyelonephritis
Obstructive uropathy
Lupus (SLE)
Alport's syndrome
32
Q

ESRD Physiology

A

↓GFR < 30mL/min
↓UOP < 400mL/day
Nitrogenous waste build-up
Fluid & electrolyte retention

33
Q

Renal Transplant

Preop

A 
Organ matching & allocation - ABO compatibility, HLA profile, & patient specific crossmatch (reactive antibodies)
EKG, stress ECHO, cardiac cath
β blockade
Autonomic neuropathy
CBC
Electrolytes
Coagulation
Dialysis - volume & electrolyte correction
Immunosuppression & antibiotic protocol
34
Q

Renal Transplant

Intraop

A 
A-line 
GETA
Plasmalyte > 0.9 NaCl
CVP 10-15mmHg
Systolic > 90 MAP > 60
Ensure adequate renal perfusion
35
Q

Renal Transplant

Postop

A

Analgesia - narcotics, PCA, or regional

Intercostal or TAP blocks

36
Q

Renal Transplant Recipient

A

Monitor reperfusion
Anticipate hypotension d/t clamping, metabolites, & acidosis
Monitor UOP
- Obstruction/irrigation
- U/S monitor thrombosis in anastomosis
- Pharmacologic therapy
Rejection - hyper-acute biopsy to diagnose

AS - N934 Advanced Principles II (18 decks)

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