Transplant Anesthesia Flashcards
Organs that can be donated
kidney, liver, lung, heart, pancreas, small intestine, cornea, skin, bone
Maximum cold ischemic times
heart & lungs = 4-6 hrs
liver = 12-24 hrs
kidneys = 72 hrs
3 types of donors
brain death donors
donation after cardiac death (DCD)
living donors
Brain Death Organ Donor Criteria
death = irreversible cessation of circulatory and respiratory functions or of all functions of the entire brain, including brain stem
Brain Death Criteria: Loss of cerebral cortical function
no spontaneous movement
unresponsive to external stim
Brain Death Criteria: Loss of Brainstem Function
Apnea
absent cranial nerve reflexes
Brain Death Criteria: Supporting Documentation
eletroencephalogram
cerebral blood flow studies
Donation after cardiac death
non-heart-beating
brain dysfunction, have electrical activity in brain
death = cessation of circulation and respiration
-life support to maximize timing
Organ recovery
- sterile, lasts up to 4 hrs
- 2 surgeons
- need anesthesia support of donor organ systems until proximal aorta clamped
When are the ventilator, IVs and monitors removed?
after clamping the proximal aorta
When would anesthesia stay after the cross-clamping?
- if lungs are being recovered
- need to hyperventilate lungs - ensure perfusion at cellular level
Viability of organs: VS requirements
- adequate resp support and organ perfusion…
- BP>100 systolic and/or CVP 8-12
- oxygen sat >96%
- UOP > 100cc/hr
Living Organ Donors
young, no hx of HTN, DM, cancer, kidney disease or heart disease
Drugs & Fluids for Organ Recovery
6-8 LR's heparin 30,000 units maybe thyroxin drip long acting NMB (pac, vec) ICU drips to maintain
PRBC’s…
- on hold for extrarenal donors
- if liver being split, 2 or more units of PRBC’s need to be in the room
