Organ Transplantation Flashcards
Death Two ways to determine:
Termination of heartbeat
Brain death
It is a legal definition
Irreversible and permanent
Loss of reflexes: Pupillary light reflex Corneal reflexes Doll’s eyes reflexes Caloric responses to iced water stimulation of tympanic membrane Absence of spontaneous respirations
A patient is transported to the ER unconscious. The patients heart is beating but there are no spontaneous respirations, no pupillary light reflex and no corneal reflexes. What is the very next step?
Inform the family that the patient is brain dead and that you must remove mechanical ventilation
If the criteria for brain death are met, there is no need to consult a neurologist, get an EEG, EKG, cerebral blood-flow study or do anything else.
Although you do not necessarily need to inform a family before you remove life support from a brain dead patient, it is always best to talk with them first
certain things that can simulate brain death
Barbiturate overdose
Hypothermia
Hypotension
Use of neuromuscular blocking agents (pancuronium, vecuronium, succinylcholine)
Always check for these
who can ask the family for organ donation?
Only the organ donor network should obtain consent for organ donation
are organ donor cards enough?
although they say what the patient wants, the family consent is still required.
can we make someone donate an organ?
Organ and tissue donation is a voluntary event at the discretion of the live donor
do we need to wait for the heart to stop beating?
You do not have to wait for a patients heart to stop in order to harvest organs; actually it is preferable to remove the organs while the heart is still beating because the viability of the transplanted organ strongly correlates to how long it was unperfused after removal
What kinds of tissue donations can be paid for?
You can be paid for:
Sperm donation
Unfertilized egg donation
Blood donation
A donor can ethically be compensated in order to cover the cost of the donor (travel cost, hotel accommodations, hospital stay, etc.) but a donor may NOT financially benefit from donation.
What can we not be paid for?
Organs
Fertilized eggs
organ donations by strangers
Desire for publicity, financial gain, internal psychological conflicts
Offers by strangers to donate organs need to be carefully reviewed to rule out problematic motives
children as organ donors
Children should ONLY be donors as a last resort and only if no other suitable adult donor can be identified, if the recipient is a close family member and if the child assents
Contraindications to transplantation:
active injection drug use or alcoholism and a history of nonadherence
prioritizing of organ recipients
Those in greatest need (will die sooner without transplantation) are given priority over stable patients
Need to maintain a period of abstinence from alcohol and adhere to medical care in cases of alcoholic liver disease prior to transplantation
May permit the liver to heal so that transplantation is not necessary
Persistent Vegetative State
No cortical function but there is preserved brainstem function (spontaneous breathing & pulse and there is wakefulness)
They are NOT aware of their environment and cannot communicate or respond to others
No purposeful activity and cannot obey verbal commands
Minimally Conscious State
Have some awareness (partial, fluctuating or inconsistent)
Awareness may be reproducible
May respond to a moving object with their eyes, respond yes or no to questions, follow simple commands, show purposeful behavior, or verbalize intelligibly
Better prognosis than a persistent vegetative state patient
