Unit 19 Organ Transplant/Donation Flashcards
What is the basic criteria for Transplantation?
Ppl who can receive
End-stage disease in a transplantable organ
Failure of conventional methods to treat condition successfully
Progression of problems associated with organ failure which may be fatal
1 What is the Uniform Anatomical Gift Act?
2 What is the National Organ Transplant Act?
3 What is the Uniform Determination of Death Act?
1 Guidelines that authorized donation of organs
2 Organ registry
3 Determined what brain death was, cessation of all function including brain stem.
What does syngeneic mean? allogenic/allograft? autologous? xenogenic?
Syngeneic: Genetically identical member of same species
“identical twins”
Allogenic: Between members of same species (typical transplant)
Autologous: To self (blood and skin)
Xenogenic: Different species (ex: use during heart valves, skin)
Who is the recipient?
How is the living donor process done?
Cadaver process?
Person receiving organ
OR to OR
Person who died, organs taken from PT on vent - absolute brain death.
Organs kept in electrolyte solution.
What are the 3 processes of the immune system recognizing something that is non-self?
Inflammation (edema, redness, warmth, vessels constricting)
Anti-body mediated immunity (B-lymphocytes produce antibodies against antigens)
Cell-mediated immunity (T-lymphocytes regulate activity of other WBCs)
What is involved in compatibility/tissue typing?
Look for comparable weight
ABO/Rh antigens on RBCs (crossmatching by mixing blood in petry dish to see how they react)
Histocompatibility antigens-Human Leukocyte antigen. (HLA) which makes more compatible -looking for 3-5 HLA matches.
What is graft rejection?
- Normal response to any foreign substance (B and T cells activated, inflammation)
- Describes immune system response to a donated tissue/organ
What is a Hyperacute Rejection?
What are the manifestations?
- Rare rejection, involves wrong blood type
- Not treatable, organ needs to be removed
- Seen within 48 hours
Manifestations: general malaise, elevated temperature, thromboses
What is Acute Rejection? describe.
How is it treated?
What is the dx by?
- Rejection occurs within 3 months to 2 years
- Tissue is vascularized
- Becomes sensitive to donor’s antigens
- Repeated episodes lead to organ damage and necrosis
- Cell mediated response
Treatable w/ immunosuppressants therapy
Dx: w/ biopsy
What is Chronic Rejection?
- Gradual deterioration over months to years (> 2 years)
- May be asymptomatic or show s and s’s of failure in transplanted organ (weight gain, increased BUN/CR)
- Treatment not usually successful, anti-rejection medications may slow process
What are lifetime immunosuppression therapy Rx’s?
Describe them.
cyclosporine:
-inhibits action of t-cells
-major immunosuppressant agent for prevention of allograft rejection.
-high degree of specificity
SE: nephrotoxic, hepatotoxic, neurotixic
tacrolimus:
-100x more potent than cyclosporine
-Useful for rescue therapy as well
SE: GI, liver, and renal dysfunction
azathioprine:
- anti metabolic
- reduces inflammation
- decreased bone marrow and B and T cells
Describe the rescue therapy drug mycophenolate mofetil and corticosteroids.
mycophenolate mofetil:
- common in kidney transplants and combo w/other Rx’s
- less toxic, newer.
- effective in rejection and rescue therapies.
corticosterioids ex: prednisone
- anti-inflammatory anf immunosuppressant
- decreases lymphocytes
What do you want to give all immunosuppressant drugs with?
Food
What is the primary cause of death following an organ transplant?
Infection because of bone marrow suppression
What is the nursing management pre-transplant?
Maintain recipient’s health
Treat chronic problems and infections
Psychiatric evaluation - is client capable of compliance?
Education: pulmonary exercise, meds, financial impact
If PT has infection before transplant, what happens?
They are temporarily taken off list.
What is the nursing management post-transplant?
Infection control (most important)
Early recognition and treatment (of infection) improves chance that rejection can be reversed
Monitor toxic effects of meds
F/E balance and I and O’s
What is Hematopoietic Stem Cell Transplant (HSCT) used for?
What is the objective regarding this?
- Standard treatment for someone with leukemia: lymphoma, aplastic anemia
- Can be autologous (your own stored) or allogenic (another person’s) stem cells
The objective is to get rid of all malignant cells w/chemo and radiation then give stem cells to replace and restore marrow function.
Describe the Hematopoietic Stem Cell Transplant (HSCT) procedure.
Obtain donor-HLA match
Obtain cells from iliac crest: OR procedure
500-1000ml aspirated
Peripheral cells are obtained in outpatient
Filtered, to deplete T cells
IV transfusion (takes body 2-4 weeks to make cells from these stem cells)
What is the donor care post-op management?
Hydrate
Pain management
Monitor complications of anesthesia
Site dry and intact
What are steps to the transplantation of Stem Cells?
- Condition PT 5-10 days by getting rid of all malignant cells w/radiation and chemo
SE: n and v, diarrhea, mucositis - Transplant and transfuse over 30 min
SE: fever, hypertension - Engraftment - key to process, cells survive and grow in PT’s bone borrow sites ~2-5 weeks
(during this time PT is thombocytopenic and susceptible to infection)
Describe Graft versus Host Disease.
- Rejection of stem cells
- Inflammation throughout whole body
- Major organs affected: skin, liver, GI tract
- The T cells from donated marrow cause the problem (graft causes issue)
Occurs in 30-70% of all BMT recipients
Can occur or persists after 100 days
What are signs and symptoms of GVHD? (graft versus host disease)
Erythematous rash
Severe sloughing
Pruritus
RUQ pain
N/V
Diarrhea
What is the most common transplant?
What are complications with this transplant?
Kidney transplant
Complications: Thrombosis Acute rejection (within two weeks) Acute tubular necrosis Oliguria Polyuria Increased BUN/CR
What is the post-op management of a kidney transplant?
IVF
I/Os
Diuretic therapy
Daily weights
Labs
Prophylactic antibiotics
Monitor for s and s’s of infection
What are a couple conditions for heart transplant?
When is the initial rejection?
< 1 year to live
< 65 years old
Initial rejection usually 3 months after transplant,
Symptoms: dysrhythmias, weakness, fatigue
What definitively indicates rejection in heart transplant?
Biopsy 1 week post transplant
Describe Lung transplant.
May be single lobe or lung
PT’s receiving have severe or irreversible problems (CF, etc) while well enough to survive sx
Usually for <55 yo
What is the post-op management of lung transplant?
Early ventilator weaning
Fluid restrictions
Bronchodilators
Early ambulation/Pulmonary exercises
Biopsy after 1 week
Describe conditions when a pancreas transplant would be appropriate.
What are complications of pancreas transplant?
CF- pancreas and lung
Diabetes- pancreas and kidneys
Complications:
- Venous thrombosis
- Drop in urine amylase
- Increased blood glucose
- Acute rejection
What is success if pancreas transplant measured by?
Measured by not excreting extra insulin
When could a liver transplant be appropriate?
Who are liver transplants most common for?
What are the signs and symptoms of acute rejection in 1-2 weeks?
ESLD
Liver transplants most common for children
S and S’s of Acu. Rejection in 1-2 weeks:
- Tachycardia
- Fever
- RUQ or flank pain
- Jaundice
- Elevated ALK phos
What is seen elevated in liver rejection?
What is needed for diagnosis?
Labs will be elevated
Biopsy is needed for definitive dx
What tissues can be donated?
Corneas Skin Bone Heart valve Saphenous veins Tendon
Describe Imminent Death referrals.
When are other instances when we would call the sharing network?
Must refer all ventilator dependent PT’s w/in 1 hour to the sharing network to allow proper evaluation of potential donor, if patient meets any of the following criteria:
- GCS 5 or <
- Loss of two or more cranial nerve reflexes
- If end of life discussions are proposed.
- Family initiates interest in donation.
What are the steps in Organ Donation Process?
1) Referral
2) Evaluation
3) Consent
4) Maintenance
5) Recovery
6) Follow-up
Describe the rescue therapy drug muromonab-CD3.
muromonab-CD3:
-Has monoclonal and polyclonal antibodies
-Selectively attacks lymphocytes /WBCs
-Most effective in 1st episode (choose different Rx on
another episode)
-Causes sensitization of PT along with serum sickness “flu-like symptoms” or anaphylactic reaction
