Solid Organ Transplant Flashcards
Uniform anatomical gift act( UAGA)
Created in 1968 is the framework to create a national organ and tissue donation agency stated that it was legal to provide organs and tissues as a gift at time of death
National Organ Transplant Act (NOTA)
Called for organ procurement and transplant network(OPTN)
Federal government started to coordinate a more comprehensive national organ transplant system in 1984
The united network for organ sharing (UNOS)
Continued work of nota better establishment of organ procurement organizations and gave them geographical locations
Strategies to increase organ donation
All hospitals must have an agreement with an opo
The hospital must notify the opo in a timely manner
The opo determines medical suitability for donation
The hospital and the opo must collaborate in family notification and education initiatives
Categories of organ donor sources
Living- must be in good health free of diabetes cancer heart and kidney disease and compatible blood type
Deceased- brain death
Deceased after cardiac death(DCD)
Determination of brain death
Must have coma, apnea, and abscence of brain stem reflexes
Complete irreversible cessation of brain functioning
Do cerebral angiography, EEG, two physicians with full physical exam
Pt must be normothermic
Application of brain death
Abscence of light and corneal reflexes, no dolls eyes, and no cold caloric response, abscence of gag reflex
Apnea testing
Don’t do if patient is cold or systolic is less than 100 and no evidence of hypoxemia
Take abg take pt off the vent for 8 mins then do another abg paco2 must be 60 or greater
Hyper acute graft rejection
Rejection that occurs very rapidly is humoral from previous antibodies that are already in the organism test for antibodies now making this less likely this happens with hrs and causes severe hypoperfusion reaction and organ is cyanotic
Graft rejection acute
Occurs in every transplanted patient call mediated rejection never humoral occurs in weeks and months after transplant occurs bc of release of lymphocytes and cytotoxic T cells that are capable of killing invader cells helper T cells up regulate
Graft rejection chronic
Combination of humoral antibody and cell mediated rejection characterized by organ becoming fibrotic and results in organ death
Induction therapy
Anticipate rejection before the actual transplant
Purpose is to induce tolerance of the transplanted graft
Immunosuppressive
Goal is to suppress the activity of helper T cells cocktail for rest of their lives of corticosteroids, calcineurin inhibitors, antimetabolites
Liver transplantation indications
Chronic hepatocellular disease Cholestatic liver disease Fulminant hepatic failure Inborn metabolic disorders Primary hepatic malignancies
Immunosuppressant medications side effects
Anemia Hyperlipemia Hypertension Bone disease Nephrotoxicity Neurotoxicity Glucose intolerance Nausea Impaired would healing Hyperuricemia Hyperkalemia Hypomagnesia Infection Malignancy
