Week 15 - Organ Donation Flashcards
Who is Alexis Carrel?
“Father of Transplant Vascular Surgery”
Recognized as pioneer of vascular anastomoses
Who is Peter Medawar?
Immunologist who developed theory of graft rejection from immunological incompatibility
-pioneered immunological drugs and earned Nobel Prize for medicine
What are the two methods of organ donation?
- Organ donation after brain death (DBD): more traditional method, performed after brain death declared
- Organ donation after cardiac death (DCD): newer method, developed to try and meet needs of more of pts due to more pts than donors, ethical challenges remain but gaining more acceptance
What types of organs are donated?
- Kidney
- Pancreas – May be Kidney/Pancreas
- Liver
- Heart
- Lungs – Single, Double or combined w/ Heart
- Small Bowel
- Bone Marrow
- Cornea
- Skin / Bone
What are the indications for organ transplant?
Single organ failure
Multi organ failure
What are contraindications for organ transplant?
- Metastatic cancer
- Infection
- MODS
- Smoking/ETOH (continues to)
- End stage failure (too far gone)
How long are each organ viable? (kidney, pancreas, small bowel, liver, lungs, bone marrow, skin/bone/cornea)
- Kidney = 24-36 hours
- Pancreas = 12-8 hours
- Small Bowel = Less than 24 hr (Difficult to preserve)
- Liver = 8-12 hrs
- Lungs = 4-6 hrs
- Bone Marrow = within 24 hrs
- Skin, Bone, Cornea = preserved in pathology dept
*varies depending on organ and other specifics including surgeon and transplant center criteria
What are the basic principles for organ transplantation?
- Strict aseptic technique!
- Standard ASA monitoring +/- A-line, CVP, etc
- Fluid and electrolyte management paramount
- Organ specific drug metabolism
- ABO organ recovery verification in EPIC prior to induction of anesthesia
- Steroids and Immunosuppressive drugs
What are the most common immunosuppressants for organ donation?
Tacrolimus
Mycophenolate
What causes the need for a kidney transplant? What is the 5 year survival rate post transplant?
ESRD caused by HTN, DM, Polycystic kidney disease, Vascular disorders, etc
5 Year Survival = 70% (compared to 30% for dialysis)
What are the preop considerations for a renal transplant?
- Thorough preop eval is crucial
- Multidisciplinary evaluation to determine eligibility (average wait time is greater than 3 years, careful medical management is vital to overall survival and bridge to transplantation)
- Evaluate status of coexisting diseases
- Dialysis within 24 hr of transplant
- Lab evaluation (CBC, PT, PTT, Blood urea nitrogen, Cr, Ca, Fluid balance)
What comorbidities are common in patients needing a renal transplant?
Cardiovascular disease:
- ischemic heart disease d/t comorbidities
- CHF caused by ischemic heart disease in 25% of pts
Hyperlipidemia, DM, PVD, Hyperphosphatemia, Hyperkalemia, Chronic Anemia
What are intraop considerations for renal transplant?
- Optimize fluid/electrolyte status prior to induction if possible (generally pt is dry to recent dialysis to optimize electrolytes)
- A line, Central line, 2 PIVs (CVC dictated due to immunosuppressive drugs)
- Induction w/ propofol or etomidate
- Muscle Relaxant w/ SUX, Cisatracurium, Rocuronium
- Steroids/ Immunosuppression (get from pharmacy, admin in order specified)
- Mannitol/Lasix, Neo vs Ephedrine, Dopamine?
What are anesthesia considerations for a live kidney donor patient?
Family member or friend is matched to recipient
- donor undergoes anesthesia and organ procured via laparoscopic method (most commonly)
- healthy donor – depends on histocompatibility
- GA +/- Regional
- starts prior to recipient induced under general
What are postop anesthetic considerations for renal transplant?
- Most often extubated and go to PACU (about 6% go to ICU)
- Closely monitor fluid status and urine output – aggressive fluid resuscitation if urine output low and pre-renal cause suspected (surgeons much prefer fluid to pressors)
- Postop pain control – highly variable and pt specific (can be severe) – generally managed by IV PCA, multimodal is best
