Organ Donation & Transplant - Quiz 2

Question 1

What is the Max Cold Ischemic Time for Heart & Lungs?

Answer 1

4 - 6 hrs.

Question 2

What is the Max Cold Ischemic Time for Livers?

Answer 2

12 - 24 hrs.

Question 3

What is the Max Cold Ischemic Time for Kidneys?

Answer 3

72 hrs

Question 4

How is Death defined?

Answer 4

Irreversible cessation of circulatory, respiratory, or all functions of entire brain

Question 5

The Organ Donor designation on a driver’s license is ______ and ______ require family persmission

Answer 5

The Organ Donor designation on a driver’s license is LEGALLY BINDING and DOES NOT require family persmission

Question 6

What are the criteria for diagnosing Brain Death?

Answer 6

Loss of Cerebral Fxn

Loss of Brainstem Fx

Supporting Documentation (EEG, CBF)

Question 7

What are common physiological changes after Brain Death?

Answer 7

Hypotension

Arterial Hypoxemia

Hypothermia

Arrhythmias

Question 8

When is anesthesia needed for Organ Procurement?

Answer 8

Anesthesia is absolutely required for Donation after Brain Death (DBD), but NOT for Donation after Cardiac Death (DCD)

Question 9

When is anesthesia no longer needed for organ recovery?

Answer 9

After clamping of Proximal Aorta, unless lungs are gonna be harvested and needs Hyperventilation & Extubation

Question 10

What inidicates adequate perfusion to maintain Viable Organs?

Answer 10

SBP > 100

CVP: 8 - 12

O2 Sat > 96%

Urine Output > 100cc/hr

Question 11

Organ Donors should have no past medical history of what?

Answer 11

HTN

DM

Cancer

Kidney Disease

Heart Disease

Question 12

Which muscle relaxants are frequently used for Organ Recovery?

Answer 12

Pancuronium & Vecuronium

Question 13

What has improved the success of organ transplants?

Answer 13

Cyclosporine

Azathioprine

OKT3

Steroids

Donor:Recipient Typing

Question 14

What are the Major indications for Kidney Transplant?

Answer 14

DM

HTN-induced Nephropathy

Glomerulonephritis

Polycystic Kidney Disease

Question 15

What is included in the Pre-Op eval for Kidney Transplants?

Answer 15

Cardiac Risks

Volume Status

Hgb: 8 or above

Fix Lytes

Gastroparesis & Aspiration Risks

Question 16

What is a critical pre-op evaluation for patients w/ DM1 undergoing Kidney Transplant?

Answer 16

Airway Evaluation & PFTs

They are stiff and have limited CROM

Question 17

Why should N₂O be avoided for Kidney Transplants?

Answer 17

Expands bowel and gets in the way

Question 18

Avoid _______ drugs because transplanted kidney is senstive to sympathomimetics and blood flow to the organ can be compromised

Answer 18

Avoid ALPHA ADRNERGIC drugs because transplanted kidney is senstive to sympathomimetics and blood flow to the organ can be compromised

Question 19

Which NMB should be used for Kidney Transplants?

Answer 19

Succinylcholine if K⁺ is Normal

otherwise, Cisatacurium or Mivacurium

Question 20

What can be given as a prophylaxis for diabetic gastroparesis regarding Kidney Transplants?

Answer 20

Sodium Citrate

Citric Acid

Reglan

H2 Blockers 6-12 hrs before induction

Question 21

When should Diuretics be given to maintain Renal Perfusion & Enhance Urine Production?

Answer 21

Before unclamping vascular supply to Transplanted Kidney

Question 22

How should Hypotension be managed during Reperfusion of the Kidney Graft?

Answer 22

Crystalloid

Colloid

Low-Dose Dopamine

Question 23

What should be given for HYPERtension during Emergence for Kidney Transplant surrgery?

Answer 23

Short-Acting Anti-Hypertensives

&

AVOID Long-Acting B-Blockers to prevent K⁺ Increase

Question 24

How do patients w/ Chronic Liver Dysfunction present regarding CV?

Answer 24

Hyperdynamic Circulation

Low PVR

Increased Cardiac Index

Question 25

What is a major pre-op eval for Liver Transplant?

Answer 25

Cardiac Function & Ischemic Potential

Question 26

What happens during the Pre-Anhepatic Phase?

Answer 26

Lysis of Adhesion Liver Mobilization Hepatic Artery, CBD, Supra & Infra Vena Cava, Portal Vein Dissection Possible Shunting Procedure to redirect Venous flow into Venous Circ.

Question 27

What are the anesthetic considerations for the Pre-Anhepatic Phase?

Answer 27

Hemorrhage & CV Instability Coagulopathy Impaired Venous Return from IVC Clamping HYPOcalcemia HYPERkalemia Metabolic Acidosis

Question 28

What happens in the Anhepatic Phase?

Answer 28

1. Clamping of Hepatic Blood Flow 1. Bicaval Clamp – ↓Preload, Profound Hypotension & Tachycardia 2. Piggyback Clamp – IVC Side-clamp – preserves some caval flow & preload 3. Venovenous Bypass – rarely used 2. Remove Liver including Vena Cava 3. New Liver Implant & Flush w/ Fluid or Colloid

Question 29

What are the anesthetic considerations during the Anhepatic Phase?

Answer 29

Hemorrhage Coagulopathy HYPOthermia ↓Renal Function Inotrope & Pressor Support Citrate Intoxication HYPOcalcemia

Question 30

What happens during the Neohepatic Phase?

Answer 30

Reperfusion - Unclamping of Portal Vein, Hepatic Artery, & Vena Cava Hypodynamic Instability

Question 31

What are the anesthetic considerations for the Neohepatic Phase?

Answer 31

Correct Lytes Keep K⁺ \< 4.5 Epi & Levo Support AVOID Fluid bolus before Unclamping Reperfusion Syndrome

Question 32

What is Reperfusion Syndrome?

Answer 32

↓CO, HR, & BP Brady-Arrythmias Rapid K⁺ Increase Severe Coagulopathy HYPOthermia

Question 33

What are some early signs of a functioning Liver Graft?

Answer 33

Intra-Op Bile Production Intra-Op Negative Base Excess Correction Improved Coagulation

Question 34

What Post-Op complication from Liver Transplant may require Re-transplantation?

Answer 34

Thrombosis of Hepatic Artery & Portain Vein

Question 35

What is Eisenmenger's Syndrome?

Answer 35

Extremely High PAP causing oxygen-poor blood to flow from right to left ventricle

Question 36

What is important aspect of a Post-Heart Transplant regarding catecholamines?

Answer 36

Denervation leading to no sensory, sympathetic, and parasympathetic innervations