transplantation

Question 1

when are organs transplanted

Answer 1

when they are failing/have failed, or for reconstruction and improving life quality

Question 2

when are life-saving transplants conducted

Answer 2

when other life-supportive methods have reached end of their use

Question 3

3 examples of life-saving transplants

Answer 3

liver, heart (e.g. left ventricular assist device), small bowel (total parenteral nutrition)

Question 4

when are life-enhancing transplants conducted

Answer 4

when other life-supportive methods are less good, or when organ is not vital but improves quality of life

Question 5

2 examples of life-enhancing transplants when other life-supportive methods are less good

Answer 5

kidney (dialysis), pancreas (selected cases when better than insulin injection)

Question 6

2 examples of life-enhancing transplants when organ is not vital but improves quality of life

Answer 6

cornea, reconstructive surgery

Question 7

when does cornea fail (these are not required - principle is different organs fail for different reasons)

Answer 7

degenerative disease, infections, trauma

Question 8

when does skin/composite fail

Answer 8

burns, trauma, infections, tumour

Question 9

when does bone marrow fail

Answer 9

tumour, hereditary diseases

Question 10

when does kidney fail

Answer 10

diabetes, hypertension, glomerulonephritis, hereditary conditions

Question 11

when does liver fail

Answer 11

cirrhosis (viral hepatitis, alcohol, auto-immune, hereditary conditions), acute liver failure (paracetamol)

Question 12

when does heart fail

Answer 12

coronary artery or valve disease, cardiomyopathy (viral, alcohol), congenital defects

Question 13

when do lungs fail

Answer 13

COPD, emphysema (smoking, environmental), interstitial fibrosis/interstitial lung disease (idiopathic, autoimmune, environmental), cystic fibrosis (hereditary), pulmonary hypertension

Question 14

when does pancreas fail

Answer 14

type 1 diabetes

Question 15

when does small bowel fail

Answer 15

mainly children with volvulus, gastroschisis, necrotising enteritis related to prematurity; in adults with Crohn’s, vascular disease, cancer

Question 16

5 types of transplantation

Answer 16

autografts, isografts, allografts, xenografts, prosthetic graft

Question 17

what is an autograft between

Answer 17

same individual

Question 18

what is an isograft between

Answer 18

between genetically identical individuals of same species

Question 19

what is an allograft between

Answer 19

between different individuals of same species

Question 20

what is an xenograft between

Answer 20

between indivuals of different species

Question 21

what can a prosthetic graft be made from

Answer 21

plastic, metal

Question 22

long term target for autograft transplanation

Answer 22

forming organs from stem cells

Question 23

examples of xenografts

Answer 23

heart valves (pig/cow), skin

Question 24

allograft transplantation options

Answer 24

solid organs (kidney, liver, heart, lung, pancreas); small bowel; free cells (bone marrow, pancreas islets); temporary e.g. blood, skin (burns); privileged sites e.g. cornea; framework e.g. bone, cartilage, tendons, nerves; composite e.g. hands, face, larynx

Question 25

2 types of allograft donor

Answer 25

dead, living

Question 26

examples of living donor organs in allograft

Answer 26

bone marrow, kidney, liver

Question 27

who can be used as a living donor in allograft

Answer 27

genetically related or unrelated (e.g. spouse, altruistic)

Question 28

in dead donors, what is DBD and how is this confirmed

Answer 28

donor after brain stem death (majority of donors), confirmed using neurological criteria

Question 29

in donor after brain stem death, what does brain injury cause death before

Answer 29

terminal apnoea has resulted in cardiac arrest and circulatory standstill (circulation established through resuscitation)

Question 30

example of death causing donor after brain stem death

Answer 30

intracranial haemorrhage, road traffic accident

Question 31

how is ischaemic damage minimised in DBD

Answer 31

organs harvested and cooled

Question 32

in dead donors, what is DCD and how is this confirmed

Answer 32

donor after circulatory death, with death diagnosed and confirmed using cardio-respiratory criteria (5 minute observation of irreversible cardiorespiratory arrest)

Question 33

describe controlled DCD

Answer 33

generally patients with catastrophic brain injuries who, while not fulfilling neurological criteria for death, have injuries of such severity as to justify withdrawal of life-sustaining cardiorespiratory treatments on grounds of best interests

Question 34

describe uncontrolled DCD

Answer 34

no or unsucessful resuscitation

Question 35

feature of ischaemia time in DCD

Answer 35

longer period of warm ischaemia time

Question 36

what is neurological criteria of death based on

Answer 36

irremediable structural brain damage of known cause

Question 37

what does neurological criteria of death rule out

Answer 37

apnoeic coma due to other things e.g. cardiovascular instability, depressant drugs, metabolic/endocrine disturbance, hypothermia, neuromuscular blockers

Question 38

what does neurological criteria of death demonstrate

Answer 38

absence of brain stem reflexes (light, touch, cold caloric, orbital pressure, cough and gag reflex, lastly apnoea test on disconnection from ventilator)

Question 39

what dead donors must be excluded

Answer 39

viral infection; malignancy; drug abuse, overdose or poison; disease of transplanted organ

Question 40

what is absolute maximum cold ischaemia time for kidney before perfusion

Answer 40

60h (ideally <24h, with other organs being much shorter)