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AP III > Transplant (1/4) > Flashcards

Transplant (1/4) Flashcards

1
Q

what was the first anti-rejection drug used for organ transplant?

A

cyclosporine

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2
Q

T/F: serologic evidence of CMV infection prevents organ donation to seropositive recipients

A

false; if CMV + donor organ goes to CMV + recipient

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3
Q

when assessing donor infection risk for organ transplant, what infectious diseases are they screening for?

A
  1. HBsAg
  2. herpes virus
  3. Tb
  4. toxoplasmosis
  5. HIV Ab
  6. CMV
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4
Q

what infections if present in the organ donor are contraindicated for organ transplant?

A
  1. HBsAg (but considered for HBsAg+ recipients or HBV)
  2. Tb
  3. HIV (considered with HIV + pt)
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5
Q

what are the different donor types

A
  1. cadaveric (DCD or DBD)
  2. living related
  3. living non-related
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6
Q

which is the more common cadaveric donor? DCD or DBD

A

DBD

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7
Q

____________ is a non beating heart donation that occurs when pt or legal guardian desires to have life sustaining therapies whithdrawn but wish to proceed with organ donation after death

A

donation after cardiac death (DCD)

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8
Q

a DCD donor must “die” within ___________ minutes in order to be considered for donation

A

60

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9
Q

for DCD, circulation and respiration must be absent for a minimum of _________ minutes before the start of organ recovery

A

2

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10
Q

to declare someone brain dead, _______ physicians must independently declare when clinical picture is consistent with irreversible cessation of brain function

A

2

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11
Q

T/F: legal and medical brain death criteria differ from state to state

A

true

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12
Q

ways to determine brain death

A
  1. absence of brainstem reflexes
  2. apnea test
  3. neuro tests
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13
Q

what are the different types of brainstem reflex tests that can be used to declare someone as “brain dead”

A
  1. pupillary response to light
  2. corneal reflex
  3. oculocephalic reflex (dolls eyes)
  4. oculovestibular reflex (cold caloric response)
  5. gag and cough reflex
  6. facial motor response (jaw reflex)
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14
Q

what are the different neuro tests that can be done to determine brain death

A
  1. auditory evoked potentials
  2. EEG
  3. transcranial doppler
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15
Q

brain death donor criteria

A
  1. comotose without response to painful stimuli or spontaneous movement
  2. lack of brainstem activity
  3. confirmed apnea test & loss of reflexes
    4 exclude other causes of reversible cerebral dysfunctions (hypothermia, hypotension, residual drug effects, toxins)
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16
Q

what is the initial physiologic response to brain death

A
  1. hyperdynamic instability
  2. hemodynamic instability

(htn, hotn, +/- tachycardia)

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17
Q

what are some issues you may experience in the OR with a brain dead donor?

A
  1. hypotension
  2. reduced CO
  3. myocardial dysfunction
  4. vasodilation
  5. thermoregulation
  6. may have difficulties with oxygenation
  7. decreased circulating ADH –> hypoNa, HypoK, and DI
  8. hyperglycemia
  9. coagulopathies
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18
Q

why do you use analgesics during anesthesia management in the DBD pt?

A

no pain perception, but the analgesic will inhibit the sympathetic response to stimulation

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19
Q

T/F: give NDMR to DBD pt in the OR

A

true - prevents the reflex somatic movement mediated by spinal reflexes

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20
Q

what is the goal for anesthesia management of the DBD pt?

A
  1. balanced anesthetic to meet needs of pt and procurement team
  2. maintain HD stability
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21
Q

anesthesia management for the DBD pt

A
  1. standard monitors
  2. A line +
  3. CL +
  4. strict I/O
  5. ventilator management (may have difficulty with Oxygenation)
  6. draw labs necessary to maintain donor status
  7. coordination with surgical teams
  8. cold protection for organs
22
Q

hemodynamic goals for the DBD patient:
MAP
HR
PaO2
PaCO2
UOP
HCT
CVP

A
  1. MAP 70-110
  2. HR 80-100
  3. PaO2 > 100
  4. PaCO2 30-35
  5. UOP 1-1.5 ml/kg/hr
  6. hct 30%
  7. CVP 6-12
23
Q

if your DBD pt is a LUNG donor, FiO2 should be maintained ______________

A

< 40%

24
Q

if the brain dead donor has hypotension in the OR, what is the first line of tx?

A

fluid!

25
Q

what fluids are preferred to tx hypotension in the brain dead patient donating lungs and/or pancreas

A

colloids

26
Q

what is the consequence of excessive fluid resuscitation in a brain dead donor?

A

results in swelling and edema which could lead to loss of organs.

27
Q

if your brain dead donor is having hypotension, and fluids did not treat, what is the inotrope of choice?

A

dopamine

28
Q

T/F: bradycardia in the brain dead patient may not respond to atropine

A

true (d/t loss of reflexes)

29
Q

if your brain dead donor is experiencing bradycardia, and atropine is not working, what should you use?

A

direct acting chronotrope: isoproterenol and/or epi

30
Q

heart and lung time to transplant

A

4-6 hours

31
Q

pancreas time to transplant

A

< 18 hours

32
Q

small bowel time to transplant

A

12 hours

33
Q

liver time to transplant

A

< 12 hours

34
Q

kidneys time to transplant

A

< 36 hours

35
Q

with organ procurement there is a risk of ischemia; what are some ways to prevent ischemia?

A
  1. harvest and preservation
  2. storage during tranportation
  3. rewarming during reperfusion
  4. reperfusion
36
Q

how do we preserve donation organs until transplant?

A

combination of hypothermia, electrolyte, and other chemical solutions

37
Q

in organ preservation ____________ will decrease metabolic needs and ______________ will maintain cellular integrity

A

hypothermia; electrolyte/chemical solutions

38
Q

what is the purpose of the hypothermia/electrolyte & chemical solutions in organ preservation?

A
  1. prevents vasospasm
  2. prevents cellular swelling
  3. prevents buildup of toxic metabolites.
39
Q

what are some common electrolytes found in organ preservation solutions

A
  1. high concentrations of K
  2. Na
  3. Mg
  4. glucose
40
Q

high concentrations of ____________ in organ preservation solutions can be an issue with reperfusion

A

potassium

41
Q

if the organ preservation solution is not completely flushed from organ when starting the reperfusion, ________________ could occur

A

hyperkalemic cardiac arrest

42
Q

__________________ is the first line of defense against hypoxic injury in the organ to be donated

A

cold preservation

43
Q

benefits of living organ donors

A
  1. higher degree of HLA matching
  2. reduced ischemic time
  3. decreased wait time
44
Q

what are some ethical and pyschological concerns with living organ donors

A
  1. psychological risk due to loss of organ
  2. coercion (including financial)
45
Q

living donors must be physical status ________

A

I - II

46
Q

if a non-directed living donor gives organ to a recipient who has a willing donor but is incompatible, and that donor gives to another individual who they are compatible with, this describes _________________

A

chained or paired donation

47
Q

if doing a living kidney donation via the laproscopic approach, which kidney is preferred?

A

the left is preferred when done laproscopically

48
Q

advantages of doing kidney donation laparoscopically

A
  1. decreased postop pain
  2. decreased hospitalization time
  3. shorter recovery
  4. improved cosmetic results
  5. better surgical exposure and longer vascular supply
49
Q

position for kidney donation surgery

A

lateral position with tabled flexed and kidney elevated (head down)

50
Q

anesthesia management for the living kidney donor

A
  1. at least 1 lg bore IV
  2. type and cross x2UPRBC
  3. GETA
  4. postop pain management (MM, pre-emptive analgesia, and/or nerve block)
  5. PONV prophylaxis
  6. heparin and protamine with clamp and unclamp
  7. lg volume crystalloid (ensure optimal fx & flow)+ mannitol and lasix (maintain blood volume and urine flow)

AP III (20 decks)

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