ORGAN DONATION AND SCREENING Flashcards
The pretransplant evaluation identifies opportunities to assess the risks for common post- transplant infections and to develop individualized preventative strategies
Organ donation and Screening
Goals of Pretransplant Screening
- To identify conditions which may disqualify either donor or recipient
- To identify and treat active infection pretransplant
- To define the risk of infection and determine strategies for preventing and mitigating posttransplant infection
- To implement preventative interventions
- To facilitate transplants from previously infected donors and recipients.
• All SOT candidates should be evaluated for _ and _
• A detailed social history is of utmost importance.
Bacterial Infections
latent syphilis and TB
There are two types of serologic tests for syphilis:
non-treponemal tests and treponemal-specific tests.
• All transplant candidates should be evaluated for __
latent TB infection
• Transplant recipients are at risk for several parasitic infections, including __ and __
Parasitic Infections
-toxoplasmosis and strongyloidiasis.
• _____________ is an uncommon but highly morbid infection after transplantation.
• Test involves detection of specific _ antibodies.
Toxoplasmosis
IgG
• ______________ is a devastating disease in transplant recipients, with 50–70% mortality in those with __ and __
• Test is done via __ and __ and Strongyloides IgG measured by _ .
• __ has a high sensitivity and specificity for diagnosing this dse.
Strongyloidiasis
- hyperinfection syndrome and disseminated infection
- serial stool ova and parasite examinations
- ELISA
- IgG measured by ELISA
• ________________ is rare, with an estimated incidence <1%, even in endemic areas.
• Screening is not recommended for serological evidence of prior infection with __ in asymptomatic transplant candidates.
Post-transplant histoplasmosis
- Histoplasma capsulatum
A proper pre-transplant evaluation also includes screening for many viral infections, including ___, _______________ and ____________.
- Viral Infections
- HIV
- hepatitis B virus (HBV)
- hepatitis C HCV
• ______ is required in pre-transplant evaluations.
• Immunologic and virologic control must be documented prior to __.
Screening for HIV
- transplantation
• All transplant candidates should be screened for __ and ___.
- HBV and HCV
The _______________ is responsible for coordination of the evaluation and preparation of patients for organ transplantation and long-term management of patients after transplant.
Transplant Coordinator
• Conduct pre-transplant interviews with prospective transplant patients and families. Interpret eligibility criteria for patients, families, physicians and outside agencies.
DIRECT PATIENT CARE
Compose written transplant summaries, clinic visit and summaries and letters.
DIRECT PATIENT CARE
Conduct post-discharge planning and education for transplant patients.
DIRECT PATIENT CARE
• Compile and review post-discharge data for ____________ of transplant patients.
DIRECT PATIENT CARE
- clinical management
• Provide direct care to transplant patients in the _______________.
DIRECT PATIENT CARE
- Outpatient Transplant Clinic
• Provide for continuity of care between __________ and __________.
DIRECT PATIENT CARE
inpatient admissions and outpatient visits
• Collaborate with _______, ____________, ____________ and _____________ to facilitate meeting patient and family needs.
DIRECT PATIENT CARE
medical faculty, other transplant coordinators, nursing personnel and other health disciplines
Select appropriate patients for organ transplantation based on ___________ and ________.
DIRECT PATIENT CARE
UW Health Transplant Program and UNOS guidelines
Provide __ and __ to support patients and their families. This requires the ability to recognize patient problems and symptoms, apply appropriate medical interventions and transplant protocols and interpreting these to community physicians and health professionals involved in the care of transplant patients.
DIRECT PATIENT CARE
- telephone consultation and follow-up
Implement and coordinate the education, selection and preparation for ___________.
DIRECT PATIENT CARE
- live kidney donors
Provide ______________ on items 12- 14 on evenings, weekends and holidays when the transplant office and Clinic is closed.
on-call service
• Collaborate in the development of protocols and guidelines for patient management.
PROGRAM DEVELOPMENT
• Support planning of and participate in clinical research projects.
RESEARCH
• Participate in teaching activities at UW Health for physicians, nurses, allied health professionals and for students in those disciplines.
EDUCATION
• Provide consultation to UW Medical Faculty, other physicians, nurses and other health care professionals who provide health care to organ transplant patients.
CONSULTATION
The Organ and Tissue Donation Process
- DIAGNOSIS
- REFERRAL
- FAMILY DISCUSSION
- MEDICAL EVALUATION
- MATCHING
- SURGICAL RECOVERY
- PRESERVATION/TRANSPORT
- TRANSPLANTATION
detect antibodies against cardiolipin and are not specific.
Non-treponemal tests
detect antibodies against specific treponemal antigens.
• Treponemal tests
• CDC specifically recommends the __ because of its superior specificity and sensitivity compared with the fluorescent treponemal antibody absorption assay.
Treponema pallidum particle agglutination (TP-PA) assay
• The two methods to assess cellular immune response include the __ and __
in vivo tuberculin skin test (TST) and ex vivo interferon gamma release assays (IGRA).
• The _ elicits a delayed–type hypersensitivity reaction after local intradermal application of purified protein derivative.
TST
measure T cell release of interferon gamma (IFN-γ) following stimulation with antigens present in _
IGRAs
M. tuberculosis
• Screening for HCV with antibodies is routine among __
SOT candidates
A reactive or indeterminate/equivocal antibody test should be followed by __
HCV RNA testing
HCV infection in potential recipients is not considered a contraindication to __, unless the patient has __.
transplantation
- cirrhosis
• Prepare and analyze pre-transplant clinical data and collaborate with other medical personnel in preparation of patients and families for transplantation; obtain medical and social histories.
DIRECT PATIENT CARE
• Coordinate pre-transplant preparations. Educate patients and families regarding all aspects of transplantation.
DIRECT PATIENT CARE
Communicate with third-party payers regarding issues of medical necessity and benefits coverage for their clients undergoing transplantation.
DIRECT PATIENT CARE
• Develop, implement and evaluate comprehensive patient education programs.
• Participate in the development and execution of quality assurance programs and projects.
PROGRAM DEVELOPMENT
• Participate in the development and implementation of research protocols and interpret the protocols for Participation of patient and family members.
Research
• Collect and analyze data for ongoing clinical research projects.
• Incorporate research findings into the __.
Research
Organ Transplant Program Practice
• Develop and present information to professional groups regarding organ transplantation and organ donation.
Education
• Develop and present information to community groups regarding organ transplantation and organ donation.
Education
• Participate in the development of marketing information regarding organ transplantation and organ donation.
Education
• Provide status reports to third-party payors.
consultation
• Provide patient status reports to community and referring physicians.
consultation
