Organ Transplant Primer Flashcards
Organ and tissue donation is regulated by
• Uniform Anatomical Gift Order
True or False
Donation organs may be acquired from living or dead hosts and may be used as whole organs, but not as partial organs.
• False, Organs may be retrieved from living or dead hosts and CAN be used whole or in part
What are some organs that may be used in parts?
- Lungs
- Liver
- Intestines
True or False
Organs being transplanted must be done in separate operations.
• False, multiple organ transplants may be done in a single surgery
What are the parameters by which donated organs are prioritized to recipients?
- ABO blood type
- Human leukocyte Antigen (HLA) system typing
- Medical urgency
- Time on waiting list
- Geographical location
What HLA blood type antigens are thought to be significant for transplantation?
• A, B, DR
What is Human leukocyte Antigen (HLA) typing?
• An attempt is made to match as many antigens as possible between HLA –A, HLA- B, and HLA-DR between donor and recipient organs
What is an HLA-DR, its function and significance for organ transplant?
- HLA-DR is an MHC class II cell surface receptor encoded by the human leukocyte antigen complex
- The HLA complex helps the immune system distinguish the body’s own proteins from proteins made by foreign invaders such as viruses and bacteria.
- By matching as many HLA-DRs as possible (x/6), it reduces the odds of specific transplanted organ rejection
For which organs are HLA matches very important?
• Kidney and bone marrow
True or False
HLA matches have little significance for liver transplants.
• True
True or False
HLA matches have little impact on heart and lung transplant compatibility.
• False, the more matches, the better
True or False
Human leukocyte Antigen (HLA) typing is done on all potential donors and recipient’s that are not related.
• False, HLA typing is done on all potential donors and recipient’s regardless of relation
Why is blood typing and crossmatching performed for organ transplants?
• To avoid lethal transfusion reactions
The recipient must receive a transplant from a compatible
• ABO blood group donor
True or False
Do not need to share the same Rh factor
• True
Major crossmatching determines compatibility between the donor’s
• Red blood cells (RBCs) and the recipient’s serum.
Minor crossmatching determines compatibility between the donor’s
• Serum and the recipient’s RBCs.
A complete blood crossmatching takes how long?
• 45mins -2hrs
What are the factors applied to crossmatching in an emergency situation?
- Incomplete xmatching may be done (10mins)
* Start xfusion w/ type O PRBCs while xmatching is completed
Incomplete typing and crossmatching increase the
• risk of complications.
Absence of _____ indicates compatibility between the donor’s and the recipient’s blood, which means that the transfusion of donor blood can proceed.
• Agglutination
A positive crossmatch indicates _____ between the donor’s blood and the recipient’s blood, which means that the donor’s blood _____ be transfused to the recipient.
- Incompatibility
* Can’t
_____ indicates an undesirable antigen-antibody reaction. The donor’s blood must be withheld, and the crossmatch continued to determine the cause of the incompatibility and identify the antibody.
• Agglutination
When blood crossmatching, what may cause a false agglutination reading?
- Recent administration of dextran or I.V. contrast media
- Previous blood transfusion (possibility of new antibodies to donor blood)
- Hemolysis due to rough handling of the sample
- Delay of testing for more than 72 hours after sample collection.
What does PRA stand for?
• Panel of Reactive Antibodies
What does a PRA indicate?
• The recipient’s sensitivity to certain Human Leucocyte Antigen (HLA)s
How is a PRA expressed?
• Percentages
What does a high PRA indicate?
• a poor chance of finding a donor as the person has a high number of cytotoxic bodies
How may plasmapheresis be helpful for a person with a high PRA?
• It can lower the number of HLAs
A positive cross-match indicates the recipient has cytotoxic antibodies to a donor and is an absolute _____ to donation moving forward.
• Contraindication
Transplant rejection occurs as a…
• Normal immune response to a foreign tissue
Transplant rejection can be controlled by the use of…
- Immunosuppression therapy
- ABO/HLA matching
- A NEGATIVE xmatch
A perfect tissue match is nearly impossible unless it comes from
- Self
* Identical twin
What is a hyperacute rejection and what is the resulting course of action to be taken?
- A xplant rejection that occurs minutes, to hours after transplantation because blood vessels are destroyed
- Action: No treatment, the organ is removed
Which organ is susceptible to a hyperacute reaction?
• Kidney
Why is a hyperacute rejection a rare event?
• The final cross-match should indicate any potential problems
When does an Acute rejection for organ xplant occur?
• A week to 6 months post xplant
An acute rejection can be reversed by taking what actions? What is the danger?
- Additional immunosuppressive therapy , increased steroid doses
- Increased risk of infection
What is the timing for Chronic organ rejection and what causes it?
- Occurs over months or years
* Causes: fibrosis (scarring)
Is Chronic organ rejection reversible?
• No
What are some important Nursing edu points for organ xplant?
- Take meds as prescribed
- Drug sfx
- IDing s/s of infection/organ rejection
- Keeping appointments
What is Graft Vs. Host Disease (GVHD)?
• GVHD occurs when the donor’s T cells (the graft) view the patient’s healthy cells (the host) as foreign, and attack and damage them.
What are the stages of GVHD?
• Stage I-IV; mild, moderate, severe, or life-threatening respectively
What is normal GVHD onset?
• 7-30 days post transplant
What are the target organs of GVHD?
- Skin
- Liver
- GI tract
What are the integumentary s/s of GVHD?
- Macropapular (flat and bumpy) rash
- Pruritic and/or painful
- Initially involves palms and soles of feet
- Can progress to generalized erythema (reddened skin) and desquamation (shedding of outer skin)
What are the hepatic s/s of GVHD?
- Mild jaundice with elevated liver enzymes
* Hepatic coma
What are the GI s/s of GVHD?
- Mild to severe diarrhea
- GI bleeding
- Malabsorption
The biggest concern for GVHD is…
• Bacterial and fungal infection
A severely immunocompromised female patient requires a blood transfusion. To prevent GVHD, the physician will order:
a. Diphenhydramine hydrochloride (Benadryl).
b. The transfusion to be administered slowly over several hours.
c. Irradiation of the donor blood.
d. Acetaminophen (Tylenol).
c. Irradiation of the donor blood.
This process eliminates white blood cell functioning, thus, preventing GVHD. Diphenhydramine HCl is an antihistamine. It’s use prior to a blood transfusion decreases the likelihood of a transfusion reaction. Option 2 will not prevent GVHD. Use of acetaminophen prevents and treats the common side effects of blood administration caused by the presence of white blood cells in the transfusion product: fever, headache, and chills
A male patient with blood type AB, Rh factor positive needs a blood transfusion. The Transfusion Service (blood bank) sends type O, Rh factor negative blood to the unit for the nurse to infuse into this patient. The nurse knows that:
a. This donor blood is incompatible with the patient’s blood.
b. Premedicating the patient with diphenhydramine hydrochloride (Benadryl) and acetaminophen (Tylenol) will prevent any transfusion reactions or side effects.
c. This is a compatible match.
d. The patient is at minimal risk receiving this product since it is the first time he has been transfused with type O, Rh negative blood
c. This is a compatible match.
Type O, Rh negative blood has none of the major antigens and is safely administered to patients of all blood types. It is also known as the universal donor. Premedicating with these agents will not prevent a major transfusion reaction if the blood type and Rh factors of the donor blood are incompatible with the recipient’s blood.
