Transplantation Flashcards
What is the difference between life-saving and life-enhancing transplantation?
Life-saving – other life-supportive methods are not fully developed or other life-supportive methods have reached the end of their possibleuse Life-enhancing – other life-supportive methods are less good e.g. Kidneys and dialysis – the organ is not vital but it improves the quality of life
What are the different types of transplants?
Autograft – within the same individual Isografts – between genetically identical individuals of the same species Allograft – between different individuals of the same species Xenograft – between individuals of different species Prothetic graft – artificial material e.g. plastic, metal
Give an example of an autograft.
Coronary artery bypass graft
What tissues can xenografts be used for?
Heart valves Skin
What are the two types of deceased donor?
Donor after brain death – brain dead but heart-beating Donor after cardiac death –non-heart beating donors
What must be confirmed with DBD donors?
Irremediable structural brain damage of known cause Apnoeic coma that is NOT due to depressant drugs, hypothermia, neuromuscular blockers etc. Must be able to demonstrate a lack of brain stem function (e.g. pupils both fixed to light)
What must be excluded before harvesting organs from a deceased donor?
Viral infection Malignancy Drug abuse, overdose or poison
How are the organs maintained once they’ve been removed?
They are rapidly cooled and perfused NOTE: absolute maximum cold ischaemia time for the kidneys is 60 hours
What is the difference between transplant selection and transplant allocation?
Selection – access to the waiting list Allocation – access to the organ
What is the nationwide system of transplant allocation based on?
Equity – fairness Efficiency – what is the best use of the organ in terms of patient and graft survival?
What are the 5 tiers of patients on the organ transplant waiting list based on?
Paediatric or adult Highly sensitised or not
What are the 7 elements that are used to decide upon organ allocation?
Waiting time HLA match and age combined HLA-B homozygosity HLA-DR homozygosity Donor-recipient age difference Location of patient relative to donor Blood group match
What are the main obstacles to donation?
Contraindication for use of that organ Family not approached for consent Family declined consent
Describe some other strategies for increasing transplantationactivity.
Use marginal donors e.g. elderly and sick Transplantation across compatibility barriers Exchange programmes – organ swaps for better tissue matching Future – xenotransplantation + stem cell research
What are the main antigens that must be considered when determining the compatibility of an organ for transplant?
ABO HLA
