Organ Transplant - EXAM 5 Flashcards
What is an autologous graft?
An autologous graft is a graft (such as a graft of skin) that is provided for oneself.
What is graft-versus-host disease?
- In bone marrow transplant, immunodeficient patient receives immunocompetent cells
- GRAFT (donated tissues) rejects HOST (recipient tissues)
- No risk with autologous or syngeneic (twin) transplant
- High risk with allogeneic (family member or MUD)
- Targets the skin, liver, GI tract
- No adequate treatment once established
- Primary concern is infection
What is brain death?
Three Findings:
- Coma/unresponsiveness
- Apnea
- Absent of non-reactive brainstem reflexes
- Pupil reflex
- Corneal reflex (blinking)
- Cough/gag reflex
- Response to painful stimuli
- Doll’s eye and Cold caloric testing
Brain death will lead to cardiac death without ventilation
What is cardiac death and what does it mean it terms of transplantation?
Typically when a person suffers a cardiac death, the heart stops beating. The vital organs quickly become unusable for transplantation. But their tissues – such as bone, skin, heart valves and corneas – can be donated within the first 24 hours of death.
- Ventilator dependent
- Family decision to withdrawl the ventilator
- Withdrawal of life-sustaining measure must occur in a controlled setting so organs can be recovered immediately after death to limit ischemic injury
What organs can be transplanted?
Heart
Kidneys
Liver
Pancreas
Lungs
Intestine
Can do parings or some. Can do partials of some.
What tissues can be transplanted?
Cornea
Skin
Bone Marrow
Heart Valves
Bone
Connective Tissue
How does one identify donors?
Donor card
Driver’s license
With death/imminent death the next of kin makes decision, even with signed donor card
What are the clinical triggers for organ donation that the RN should be alert for?
The RN must know these and refer to Organ Procurement Organization (OPO) within 2 hours of identification
- Ventilated patient with poor prognosis
- Medically suitable
- One of more of the following:
- GCS of 5 or less
- Loss of 2 or more brainstem reflexes
- Initation of brain death testing
- Beginning discussion of end-of-life or ventilator withdrawal
Why are only ventilated patients eligible donors?
Organs must be perfused and oxygenated until the moment of recovery
Brain death leads to cardiac death without ventilation
Who requests the donation from the family?
- The Organ Procurement Organization (OPO) representative
- RN/MD or other health care providers are not designated requestors
- Input of health care team is VITAL to ensure a timely and respectful approach by Donor Recovery Network
How is a donor considered eligible?
- Labs
- Age
- Reason for admission
- Current medical status
- Infectious diseases
- Past medical history
What is matching and testing?
- Human Leukocyte Antigen (HLA) matching: best care scenario is 6/6 match with donor and recipient
- ABO matching
- Crossmatching right before transplant: + crossmatch means cytotoxic antibodies to donor = transplant contraindicated
Who gets the organs?
- UNOS (United Network of Organ Sharing) ensures organs are given fairly using an objective point system
- Organ offered to recipient with most points in local area (then regional then national)
What is recipient point ranking based on?
- Matching (HLA/ABO)
- Medical urgency
- Immune status
- Time on waiting list
- Geographic location
- Age
- Body size
- Recipient selection is not based on gender, socioeconomic status, celebrity status, and ethnicity/race unless it affects matching
What is rejection?
Normal immune response to foreign tissue
