Organ Donation Flashcards
Describe the waiting list process for organ transplants?
- get a referral
- gather information
- select transplant center
- schedule an evaluation appointment
- get on the list
What factors are considered when deciding to allocate an organ?
- ABO blood typing
- tissue typing
- size
- waiting time
- severity of illness/degree of medical urgency
- geographic location
What are the criteria for an organ transplant?
- presence of end stage disease in a transplantable organ
- failure of conventional therapy to treat the condition successfully
- absence of untreatable malignancy/irreversible infection
- absence of a disease that would attack the transplanted organ/tissue
What are the characteristics of transplant candidates?
- demonstrate emotional and psychological stability
- have an adequate support system
- be willing to comply with lifelong immunosuppressive drug therapy
- *age limits, criteria of substance abuse are specific to transplant facility**
Where do organs come from?
- cadavers
- living donors
What are some listed preoperative issues?
- weakness
- prolonged hospitalization
- fatigue
- extended confinement to bed/home
- poor functional mobility including gait
- poor breathing mechanics
- poor airway clearance
- poor endurance
- balance deficits
- fall risk
- loss of ROM
- loss of functional independence
- skin breakdown
- dyspnea
- pain
- edema
What are the pre-transplant hospitalizations for liver failure?
hepatic infections
What are the pre-transplant hospitalizations for kidney failure?
- dehydration
- DM complications
What are the pre-transplant hospitalizations for pancreatic failure?
complications from DM
What are the pre-transplant hospitalizations for intestinal failure?
- bowel obstructions
- symptom of liver failure
What are the pre-transplant hospitalizations for heart failure?
- ischemic and non-ischemic causes
What are the pre-transplant hospitalizations for lung failure?
- infection
- COPD exacerbation
What is the typical post-op care for a donor?
- take off mech vent in recovery room and transferred to general surgery/transplant ward
- VS and CBC monitored for SxS of post-op bleeding
- pts OOB and ambulating by POD1
- avg duration of hospitalization ranges from 1-2 days (kidney) to 8 days (simultaneous pancreas-kidney)
- PT is only involved in instances of complications
What is typical post-op care for a recipient?
focus on:
- allograft function
- rejection
- infection
- AE of immunosuppressants
- complications related to surgical/medical rejection, infection
What are the complications that may occur following an organ transplantation?
- rejection
- infection
Describe a transplant rejection
the leading problem of organ transplant
- requires lifelong immunosuppressant drugs
- delicate balance between suppressing organ rejection and life-threatening suppression of immune function
What are the general SxS of a transplant rejection?
- flu-like symptoms
- fever > 101
- pain over transplant
- fatigue
- specific to organ
What are the approaches to post-transplant management?
- induction immunosuppression
- maintenance immunosuppression
- anti-rejection immunosuppression
What are the types of graft rejections?
- hyperacute
- acute
- chronic
Describe hyperacute graft rejection
- occurs within 48hrs of transplant surgery
- graft becomes non-functional within hours/days
- usually due to ABO blood group of HLA typing
- usually unresponsive to tx
- requires removal of transplant and subsequent re-transplantation
Describe acute graft rejection
- an adaptive response involving T cells, mediated by CD8 cells, CD4 cells, or both
- may occur within 3mo - 1 yr post-transplant
- treatable but requires early intervention
- anti-rejection drugs used
What may decrease the likelihood of an acute graft rejection?
- verifying ABO compatibility
- crossmatching between donor and recipient
- HLA matching
Describe chronic graft rejection
- most likely an antibody mediated process involving T and B lymphocytes
- occurs within a few months post-op
- gradual and progressive deterioration of the graft
- retransplantation will eventually be required
What may occur with chronic rejection in the lungs?
bronchiolitis obliterans
What may occur with chronic rejection in the heart?
cardiac transplant vasculopathy
What may occur with chronic rejection in the kidney?
transplant nephropathy/glomerulopathy
What may occur with chronic rejection in the liver?
- ductopenic rejection
- vanishing bile duct syndrome
Describe Acute Graft vs Host Disease (Acute GVHD)
the donor organ rejects the recipient body
- causes tissue destruction via immune response
- causes a cytokine storm
- contributes to post-transplant mortality in 15-40% of pts
What are the symptoms of Acute GVHD?
- hepatitis
- dermatitis
- GI issues
Describe Chronic Graft vs Host Disease (Chronic GVHD)
- multiple organ toxicity
- develops in 15-50% of pts who survive 3months post-transplant
- involves integumentary, ocular, GI, and a range of other organ dysfunction
What are the general symptoms of GVHD?
- abdominal pain
- NVD
- skin rash
- specific to organ
What is a pt at increased risk for following an organ transplant?
increased susceptibility to bacterial, fungal, and viral infections
What is infection following transplant the leading cause of?
- critical illness
- hospitalization
- morbidity
- mortality
What is given prophylactically to prevent infection following transplant?
- antivirals
- antibacterials
- antifungals
What are the SxS of infection following a transplant?
- temperature > 100.5F
- fatigue
- shaking
- chills
- body aches
- sweating
- diarrhea > 2 days
- dyspnea
- cough/sore throat
What are typical PT guidelines for LOS?
typically 3-16 days but depends on the type of transplant
- shortest: kidney
- longest: simultaneous pancreas kidney
What are some reasons that transplant recipients are often deconditioned/in poor health going into surgery?
- lengthened recovery time due to pre-op deficits
- generalized weakness from disease process
- liver transplant: extreme weakness/fatigue
- heart/lung transplants: decreased O2 capacity
What should PT be aware of following a transplant?
- PT is safe as long as the pt is stable
- be aware of GVHD SxS
- be aware of organ rejection SxS
- coordinate the best time to tx pt based on meds and fatigue level
What MAP ensures adequate organ perfusion?
> 60-70mmHg
What interventions will PT be most focused on following transplant?
- gas exchange
- airway clearance
- positioning
- therex
- transfer training
- gait training
What are some additional PT guidelines for post-op transplant?
- infection control
- mobilization (early, encourage ambulation, less complicated : within 1-2 days)
- appropriate activity modification
- continuously monitor VS
- exercise may continue if rejection is mild-mod
- be aware of immunosuppressive agent effects
- consider appropriate outcome measures
- pts will fatigue easily and require frequent rest breaks
What are important parts of patient education for this population?
- pre-op expectations
- customized HEP
- avoid strenuous exercise that puts stress on the incision site for 2 months post-op
- no contact sports (for life) following transplant
