test 8 organ matching

Question 1

When organ matching, look at:

Answer 1

 ABO Blood Compatibility
 Overall body size
         Match must be within 20% of body weight
 HLA Cross match
         Some patients are sensitized to antigens due to pregnancy, prior transplant, or blood transfusion.
 Medical urgency
 Priority on UNOS Registry
 Geographic distance from donor

Question 2

Recipient Prioritization for heart transplantation Status 1A

Answer 2

• Mechanical circulatory support
  - very critical patient
  - VAD until clinically stable (<30 days) or with objective medical evidence of significant device-related complications
• Mechanical ventilation
• Continuous infusion of high dose inotropes or multiple inotropes

Question 3

Recipient Prioritization for heart transplantation Status 1B

Answer 3

• VAD beyond 30 days

- Continuous infusion of IV inotropes

Question 4

Recipient Prioritization for heart transplantation Status 2

Answer 4

• Any candidate not meeting criteria for status 1A or 1B

Question 5

Waiting List Criteria for organ matching

Answer 5

 Status code and time within the status code

 Highest medical urgency and lowest short term survival are assigned higher codes.

Question 6

How does the waiting list work

Answer 6

 Offered to local status 1 patients first, Status 1A before Status 1B.
 No match? Offered to Status 1 patients within 500 mile radius.
 No match? Offered to Status 2 local patients.
 Repeat at 1000 mile radius, and 1500 mile radius.

Question 7

Go out for procurement

Answer 7

 Donor heart is arrested with a cardioplegia/ preservation solution.
 Atria are transected at the midatrial level
 Leave multiple pulmonary venous connections to the LA intact.
 Transect the aorta and PA just above the semilunar valves
 Heart is cooled topically.
 Ischemic time – 3-4 hours!! (can do up to 5-6 hours – not ideal!!)

Question 8

Surgical technique for Recipient of the heart

Answer 8

 Re-anastomosis of midatrial level
 Start at atrial septum
 Generous “cuff” of donor RA, so SA node will be included in transplant
 Great vessels connected above the Semilunar valves.
 Recently, bi-atrial technique has been modified
 Leave donor atria in tact and make the anastomosis at the SVC and IVC and Pulmonary Veins
 Called Bicaval technique
 Notice less distortion of the aortic valve
 Improved atrial and ventricular function
 Less AI
 Less arrhythmias/ heart block.

Question 9

When the surgeon is putting in the new heart, what direction does the surgeon work in

Answer 9

• work from posterior to anterior

Question 10

Post operative course

Answer 10

 Same as a normal cardiac case
 Patient will be on immunosuppression drugs
 Will require pacing for a few days
 Takes 2-3 days for the SA node to come back and “reset”