Transplant (1/4) Flashcards
what was the first anti-rejection drug used for organ transplant?
cyclosporine
T/F: serologic evidence of CMV infection prevents organ donation to seropositive recipients
false; if CMV + donor organ goes to CMV + recipient
when assessing donor infection risk for organ transplant, what infectious diseases are they screening for?
- HBsAg
- herpes virus
- Tb
- toxoplasmosis
- HIV Ab
- CMV
what infections if present in the organ donor are contraindicated for organ transplant?
- HBsAg (but considered for HBsAg+ recipients or HBV)
- Tb
- HIV (considered with HIV + pt)
what are the different donor types
- cadaveric (DCD or DBD)
- living related
- living non-related
which is the more common cadaveric donor? DCD or DBD
DBD
____________ 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
donation after cardiac death (DCD)
a DCD donor must “die” within ___________ minutes in order to be considered for donation
Testing purposes: 30 min
Real answer: 60
for DCD, circulation and respiration must be absent for a minimum of _________ minutes before the start of organ recovery
2
to declare someone brain dead, _______ physicians must independently declare when clinical picture is consistent with irreversible cessation of brain function
2
T/F: legal and medical brain death criteria differ from state to state
true
ways to determine brain death
- absence of brainstem reflexes
- apnea test
- neuro tests
what are the different types of brainstem reflex tests that can be used to declare someone as “brain dead”
- pupillary response to light
- corneal reflex
- oculocephalic reflex (dolls eyes)
- oculovestibular reflex (cold caloric response)
- gag and cough reflex
- facial motor response (jaw reflex)
what are the different neuro tests that can be done to determine brain death
- auditory evoked potentials
- EEG
- transcranial doppler
brain death donor criteria
- comotose without response to painful stimuli or spontaneous movement
- lack of brainstem activity
- confirmed apnea test & loss of reflexes
4 exclude other causes of reversible cerebral dysfunctions (hypothermia, hypotension, residual drug effects, toxins)
what is the initial physiologic response to brain death
- hyperdynamic instability
- hemodynamic instability
(htn, hotn, +/- tachycardia)
what are some issues you may experience in the OR with a brain dead donor?
- hypotension
- reduced CO
- myocardial dysfunction
- vasodilation
- thermoregulation
- may have difficulties with oxygenation
- decreased circulating ADH –> hypoNa, HypoK, and DI
- hyperglycemia
- coagulopathies
why do you use analgesics during anesthesia management in the DBD pt?
no pain perception, but the analgesic will inhibit the sympathetic response to stimulation
T/F: give NDMR to DBD pt in the OR
true - prevents the reflex somatic movement mediated by spinal reflexes
what is the goal for anesthesia management of the DBD pt?
- balanced anesthetic to meet needs of pt and procurement team
- maintain HD stability