Surgery: Transplant Flashcards
what was the first transplant and when was it?
1869- skin graft
first transplant of a cornea? kidney? deceased donor organs? heart? pancreas?
(maybe weeds) ?
cornea: 1906
*kidney: 1954
deceased donor: 1962/63
*heart: 1967/68
pancreas: 1968
what year did Congress passes the Uniform Anatomical Gift Act? what is this?
1968 makes donating organs and tissues legal
Organ Procurement and Transplantation Network: what does it do?
to ensure fair and equitable allocation of donated organ and tissues.
United Network for Organ Sharing (UNOS): what does it do?
provides services for equitable access and allocation of organs and sets the membership criteria and standards for transplant centers in the U.S.
what is brain death? how is it diagnosed?
clinical Dx
total cessation of brain function, including brain stem function
clinical neuro finding: Dx of brain death: absence of pupillary response
Absence Pupillary Response
Typically, fixed and dilated mid position pupils between 4-6 mm
clinical neuro finding: Dx of brain death: absence of pupillary response: oculocephalic testing
Doll’s eye
clinical neuro finding: Dx of brain death: absence of pupillary response: facial sensation and motor response
Facial sensation – Absent Corneal Reflex
Motor response – Absent Painful Stimuli
(Nailbed pressure, TMJ pressure )
clinical neuro finding: Dx of brain death: absence of pupillary response: Pharyngeal and Tracheal Reflexes
Absent Cough & Gag reflexes response to bronchial suctioning.
Apnea testing: 6 steps and what is a positive result?
- Baseline ABG
- Continuous O2 at 6 L/min
- Remove Vent
- Wait for approximately 8 minutes – PaCO2 should raise 3 mm Hg per
- Observe pt’s abdomen and chest for movements
- Repeat ABG after 8 minutes
-Positive Apnea Test if PaCO2 > 60 mm Hg or > 20 mm Hg from Baseline ABG
what does positive apnea testing mean?
Positive as long as their is exclusion of confounding factors, absent brain stem reflexes and coma; therefore, the clinical diagnosis of brain death can be made.
brain death: two confirmatory Dx tests
- CT scan: diffuse brain edema
- cerebral angiogram: No intracerebral filling at the level of the carotid bifurcation or Circle of Willis = Empty “ Champagne Glass sign”
what temperature is ideal for neurological testing? what would be a complication of this?
(Temp > 32.2; best if > 35.5)
Temp below 35C (hypothermia)
what are the complications of neuro testing for Dx of brain death?
drug and metabolic complications
hypothermia
shock
children (cranial nerves maybe not fully developed)
spontaneous body movements (spinal reflexes)
donation after cardiac death (DCD)
Possible where life support is to be voluntarily withdrawn
Abdominal organs only
DCD process: timing and what professional must declare it?
Cardiopulmonary Arrest must occur within 90 minutes of withdrawal
– > If no arrest in 90 minutes, patient will be transferred to a non-ICU bed
Patient declared dead by cardiopulmonary criteria by a non-transplant-related MD ( No palpable carotid pulse
ECG: Non-sustaining rhythm (PEA, Asystole, VF) )
donor designation VA law
Virginia law requires the donor’s advance directive to be honored (like on your drivers license)
Goals of donor management (what do we want for a viable organ)?
- Oxygenation: PaO2 > 100 mmHg
- Hydration and Perfusion
- Normothermia
- Asepsis
- Normalized lab values
of the “goals for donor mgmt” which is the most important determinant of organ viability ?
hydration and perfusion:
Optimal organ perfusion occurs at systolic pressures > 100 mmHg
autograft vs isograft
Autograft – Same individual is both donor and recipient e.g. Blood Donation
Isograft – Donor and recipient are genetically identical e.g. Twins
allograft vs xenograft
Allograft – Donor and recipient are genetically dissimilar, but of the same species e.g. Organ Transplant
Xenograft – Donor and recipient belong to different species e.g. Pig Heart Valve
orthotopic vs heterotopic vs paratopic
Orthotopic – Donor Organ is placed in normal anatomic position e.g. Liver, Heart
Heterotopic – Donor organ is placed in a different site than the normal anatomic position e.g. Kidney is placed at the Iliac artery/vein
Paratopic – Donor organ is placed close to the original organ
3 meds for transplant recipient
antiviral- valcyte
Abx - bactrim DS
antifungal- diflucan
