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Acute Care > Organ Donation > Flashcards

Organ Donation Flashcards

1
Q

Describe the waiting list process for organ transplants?

A
  • get a referral
  • gather information
  • select transplant center
  • schedule an evaluation appointment
  • get on the list
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2
Q

What factors are considered when deciding to allocate an organ?

A
  • ABO blood typing
  • tissue typing
  • size
  • waiting time
  • severity of illness/degree of medical urgency
  • geographic location
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3
Q

What are the criteria for an organ transplant?

A
  • 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
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4
Q

What are the characteristics of transplant candidates?

A
  • 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**
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5
Q

Where do organs come from?

A
  • cadavers

- living donors

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6
Q

What are some listed preoperative issues?

A
  • 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
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7
Q

What are the pre-transplant hospitalizations for liver failure?

A

hepatic infections

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8
Q

What are the pre-transplant hospitalizations for kidney failure?

A
  • dehydration

- DM complications

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9
Q

What are the pre-transplant hospitalizations for pancreatic failure?

A

complications from DM

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10
Q

What are the pre-transplant hospitalizations for intestinal failure?

A
  • bowel obstructions

- symptom of liver failure

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11
Q

What are the pre-transplant hospitalizations for heart failure?

A
  • ischemic and non-ischemic causes
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12
Q

What are the pre-transplant hospitalizations for lung failure?

A
  • infection

- COPD exacerbation

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13
Q

What is the typical post-op care for a donor?

A
  • 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
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14
Q

What is typical post-op care for a recipient?

A

focus on:

  • allograft function
  • rejection
  • infection
  • AE of immunosuppressants
  • complications related to surgical/medical rejection, infection
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15
Q

What are the complications that may occur following an organ transplantation?

A
  • rejection

- infection

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16
Q

Describe a transplant rejection

A

the leading problem of organ transplant

  • requires lifelong immunosuppressant drugs
  • delicate balance between suppressing organ rejection and life-threatening suppression of immune function
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17
Q

What are the general SxS of a transplant rejection?

A
  • flu-like symptoms
  • fever > 101
  • pain over transplant
  • fatigue
  • specific to organ
18
Q

What are the approaches to post-transplant management?

A
  • induction immunosuppression
  • maintenance immunosuppression
  • anti-rejection immunosuppression
19
Q

What are the types of graft rejections?

A
  • hyperacute
  • acute
  • chronic
20
Q

Describe hyperacute graft rejection

A
  • 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
21
Q

Describe acute graft rejection

A
  • 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
22
Q

What may decrease the likelihood of an acute graft rejection?

A
  • verifying ABO compatibility
  • crossmatching between donor and recipient
  • HLA matching
23
Q

Describe chronic graft rejection

A
  • 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
24
Q

What may occur with chronic rejection in the lungs?

A

bronchiolitis obliterans

25
Q

What may occur with chronic rejection in the heart?

A

cardiac transplant vasculopathy

26
Q

What may occur with chronic rejection in the kidney?

A

transplant nephropathy/glomerulopathy

27
Q

What may occur with chronic rejection in the liver?

A
  • ductopenic rejection

- vanishing bile duct syndrome

28
Q

Describe Acute Graft vs Host Disease (Acute GVHD)

A

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
29
Q

What are the symptoms of Acute GVHD?

A
  • hepatitis
  • dermatitis
  • GI issues
30
Q

Describe Chronic Graft vs Host Disease (Chronic GVHD)

A
  • 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
31
Q

What are the general symptoms of GVHD?

A
  • abdominal pain
  • NVD
  • skin rash
  • specific to organ
32
Q

What is a pt at increased risk for following an organ transplant?

A

increased susceptibility to bacterial, fungal, and viral infections

33
Q

What is infection following transplant the leading cause of?

A
  • critical illness
  • hospitalization
  • morbidity
  • mortality
34
Q

What is given prophylactically to prevent infection following transplant?

A
  • antivirals
  • antibacterials
  • antifungals
35
Q

What are the SxS of infection following a transplant?

A
  • temperature > 100.5F
  • fatigue
  • shaking
  • chills
  • body aches
  • sweating
  • diarrhea > 2 days
  • dyspnea
  • cough/sore throat
36
Q

What are typical PT guidelines for LOS?

A

typically 3-16 days but depends on the type of transplant

  • shortest: kidney
  • longest: simultaneous pancreas kidney
37
Q

What are some reasons that transplant recipients are often deconditioned/in poor health going into surgery?

A
  • lengthened recovery time due to pre-op deficits
  • generalized weakness from disease process
  • liver transplant: extreme weakness/fatigue
  • heart/lung transplants: decreased O2 capacity
38
Q

What should PT be aware of following a transplant?

A
  • 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
39
Q

What MAP ensures adequate organ perfusion?

A

> 60-70mmHg

40
Q

What interventions will PT be most focused on following transplant?

A
  • gas exchange
  • airway clearance
  • positioning
  • therex
  • transfer training
  • gait training
41
Q

What are some additional PT guidelines for post-op transplant?

A
  • 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
42
Q

What are important parts of patient education for this population?

A
  • 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

Acute Care (11 decks)

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