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Levi's Class 2014 > Week 4 Organ Transplantation, Donation, and Procurement > Flashcards

Week 4 Organ Transplantation, Donation, and Procurement Flashcards

1
Q

What organs can be transplanted:

A
  • Kidney
  • Liver
  • Lung
  • Heart
  • Heart and Lung
  • Pancreas
  • Small intestine
  • Cornea
  • Skin
  • Bone
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2
Q

T/F: An individual’s signature on a driver’s license or donor card indicating their desire to donate their organ is NOT legally binding and does require family permission.

A

FALSE

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3
Q

What are the three classification of an organ donor?

A
  • Brain Death Donors
  • Donation After Cardiac Death (DCD)
  • Living Donors
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4
Q

How does the US Uniform Determination of Death ACT (1980) define DEATH:

A

-Irreversible cessation of circulatory and respiratory functions, or of all functions of the entire brain, including the brain stem.

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5
Q

What are the criteria for diagnosis of BRAIN DEATH:

A

-Loss of cerebral cortical function
>No spontaneous movement
>Unresponsive to external stimuli

-Loss of Brainstem Function
>Apnea
>Absent cranial nerve reflexes (papillary,
corneal, oculocephalic, oculovestibular)

-Supporting Documentation
>EKG
>Cerebral blood flow studies (angiography,
transcranial Doppler, xenon scan)

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6
Q

What are the four common physiologic derangements after brain death?

A
  • Hypotension
  • Arterial hypoxemia
  • Hypothermia
  • Cardiac dysrhythmias
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7
Q

What causes hypotension after brain death?

A
  • Hypovolemia (diabetes insipidus, hemorrhage)

- Neurogenic shock

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8
Q

What causes Arterial hypoxemia after brain death?

A
  • Neurogenic pulmonary edema
  • Aspiration
  • Pneumonia
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9
Q

What causes hypothermia after brain death?

A

-Hypothalamic infarction

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10
Q

What causes cardiac dysrhythmias after brain death?

A
  • Hypothermia
  • Arterial hypoxemia
  • Electrolyte abnormality
  • Myocardial ischemia
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11
Q

Anesthesia management is _____ for organ donation after brain death. (DBD)

A

required

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12
Q

Anesthesia management is _____ for organ donation after cardiac death. (DCD)

A

not required

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13
Q

T/F: Approximately 44% of organ donation come from living organ donors?

A

TRUE

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14
Q

What is the ages of living donors?

A

18 - 60 year of age

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15
Q

Are living organ donors usually related?

A

YES

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16
Q

A living organ donor must not have any of this on their physical history?

A
  • Hypertension
  • Diabetes
  • Cancer
  • Kidney disease
  • Heart desease
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17
Q

What are some ABSOLUTE contraindication to organ IMPLANTATION?

A
  • Active uncontrolled infection
  • AIDS
  • Inability to tolerate immune suppression
  • Severe cardiopulmonary/medical condition
  • Continued drug or alcohol abuse
  • Extrahepatic Malignancy
  • Inability to comply with medical regimen
  • Lack of psychosocial support
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18
Q

What are some contraindication to solid organ transplantation?

A

-Active infectious process until treated and infection resolved

-Severe irreversible pulmonary hypertension
>not a canidate for heart transplant
>may be a candidate for heart lung transplant

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19
Q

Frequency of skin and ______________ CA in transplant patients has increased ~ due to loss of protective effects of and active ________ _______.

A
  • lymphoproliferative

- immune system

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20
Q

What immunosuppressive regimans have increase success of transplantation?

A
  • Cyclosporine (1980)
  • Azathiopine
  • OKT3
  • Steroids ~ prednisone and methylprednisolone
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21
Q

T/F: Success of transplantation of an organ due to increase donor:recipient tissue typing.

A

TRUE

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22
Q

What factors play a role in post transplantation organ function?

A
  • Donor demographics
  • Organ ischemic time
  • Mechanismof death of donor
  • Medical condition of recipient
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23
Q

What are the major indications for Kidney transplantation?

A

-Diabetes mellitus
-Hpertension induced nephropathy
-Glomerulonephritis
Polycystic kidney Disease

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24
Q

What is the graph survival rate of a kidney at 5 years that are living donors?

A

81%

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25
Q

What preparation is needed for transplant?

A
  • Cardio pulmonary
  • Extent of renal failure
  • Electrolyte balance being normal
  • Questionable preoperative renal dialysis
  • normal volumes
26
Q

What physiologic disturbances often present before RENAL transplantion?

A

-Peripheral neuropathy
-Lethargy
-Anemia
-Platelet dysfunctin
-Pericarditis
-Systemic hypertension
-Depressed ejection fraction
-Pleural effusions
Skeletal muscle weakness
-ileus
-Glucose intolerance

27
Q

What type of anesthesia will most likely be given for renal transplantation?

A

-General

28
Q

What is the optimal fluid status and renal perfusion?

A

-CVP ~ 10 - 15 mmHg

29
Q

Anesthesia management for renal transplantation is?

A
  • Stimulation decreases after dissection of fascia
  • Avoid hypotension(could be relative due to much opiod use)
  • do not use a ALPHA ADRENERGIC drugs because transplant kidney is sensitive to it.
30
Q

How would you maintain renal perfusion pressure and enchance urine production

A
  • Mannitol

- Loop Diuretics

31
Q

T/F: Dopamine is a good way to maintain you anesthesic.

A

FALSE

32
Q

Prompt urine production is occurs at __% with living donor transplant and __% decrease donor transplant.

A
  • 90

- 40-70

33
Q

If urine output is decreased after renal transplant what could it mean?

A
  • May indicate mechanical impingement of graft, anastamosing vessel, or ureter.
  • Intraoperative ultrasounay
34
Q

What vitals may be prominent on emergence of a renal transplant patient and what would be done?

A
  • Ranal transplant

- Start anti hypertensive drugs

35
Q

What type of pain will a renal transplant patient have?

A
  • Mild to moderate

- Controlled by IV opiods

36
Q

T/F: Epidural catheters a used in the management of renal transplant patients.

A

FALSE

37
Q

Will renal transplant patients still suffer from primary systemic diseases (DM, HTN, etc..).

A

YES

38
Q

What will occur with renal excretion of drugs with a renal transplant patient?

A

-It will be decreased than that of a person with native kidneys.

39
Q

What is the 10 year survival rate of a liver transplant?

A

~ 60%

40
Q

What are indication for a liver transplant?

A
  • End Stage Liver Disease with Life Threatening Complication
  • Acute Hepatic Necrosis
  • Chronic Hepatitis
  • Cholestatic Disease
  • Alcoholic Cirrhosis
  • Metaboic diseases
  • Malignant disease of liver
41
Q

What might be the effect of ACUTE HEPATIC NECROSIS?

A
  • Viral hepatitis
  • Drug toxicity
  • Toxins
  • Wilson’s disease
42
Q

What might be the effect of CHRONIC HEPATITIS?

A
  • B,C,D
  • Autoimmune hepatitis
  • Chronic drug toxicity
  • Cryptogenic cirrhosis
43
Q

What might be the effect of CHOLESTATIC DISEASE?

A
  • Primary/secondary biliary cirrhosis
  • Sclerosing cholangitis
  • Biliary Atresia
  • Cystic fibrosis
44
Q

Would an alcoholic ever be considered for a liver transplant?

A

-Yes, if abstinence for alcohol for 6 month with ongoing treatment and evaluation

45
Q

What might be the effect of malignant disease of liver?

A
  • Hepatocellular carcinoma
  • Carcinooid tumor islet cell tumor
  • Epithelioid hemangioendothelioma
46
Q

Patient’s with chronic liver dysfunction and cirrhosis have a ________ circulation with _____ peripheral vascular resistance and an _______ cardiac index.

A
  • hyperdynamic
  • low
  • increased
47
Q

T/F: The cause of hepatic encephalopathy is believed to be multifactorial.

A

TRUE

48
Q

Liver failure would cause what to the central nervous system?

A
  • Hepatic encephalopathy

- Increased intracranial pressue (acute liver failure)

49
Q

Liver failure would cause what to the cardiac system?

A
  • Hyperdynamic circulation

- Cirrhotic cardiomyopathey

50
Q

Liver failure would cause what the the respiratory system?

A
  • Hepatopulmonary sysndrome (ARTERIAL HYPOXIMIA

- Portopulmonary hypertension

51
Q

Liver failure would cause what to the gastrointestinal system?

A
  • Portal HTN
  • Upper gastrointestinal bleeding
  • Ascites
52
Q

Liver failure would cause what to the hematologic system?

A
  • Anemia
  • Thrombocytopenia
  • Prolonged prothrombin time and plasma thromboplastin time
  • Decreased plasma fibrinogen concentration
  • Disseminated intravascular coagulation
  • Protein C and S deficiencyL
53
Q

Liver failure would cause what to the Renal symptoms?

A
  • Hepatorenal syndrome

- Acute tubular necrosis

54
Q

What is the preanhepatic phase?

A
  • Dissection phase

- Incision and access to the liver is obtained

55
Q

What is the anhepatic phase?

A

-Liver is isolated from the circulation
>Removal of native liver
>Implantation of donor liver

56
Q

What is the neohepatic phase?

A

New liver is reperfused
>Surgical completion of remaining anastamosis
>Hemostasis
>Closure

57
Q

What anesthesia management is done during the prehepatic phase?

A
  • Hemorrhage concern
  • Venous pooling associated with sudden decrease in intraabdominal pressue
  • Impaired venous return from surgical retraction
  • Hypocalcemia
  • Hyperkalemia
  • metabolic acidosis
58
Q

What anesthesia managment is done during the anhepatic phase?

A
  • Cardiac output and systemic blood pressure may need to be supported with inotropes and vasopressors.
  • Venovenous bypass may be used to minimize the reduction in preload, cardiac output and to prevent splanchnic congestion.
  • Citrate intoxication may occur from rapid infusion of large volumes of blood in absence of liver function.
  • Calcium administration if patient is hypocalcemic
59
Q

What anesthesia is done during the neophepatic phase?

A
  • Severe hemodynamic instability may occur with unclamping of portal vein (reperfusion syndrome)
  • May need potent vasopressors
  • Hemodynamic typically stabilize once allograft begins to function
60
Q

What are some initial indirect signs the graft is working?

A
  • Intraoperative bile production
  • Intraoperative spontaneous correction of negative base excess
  • Improvement in coagulation
61
Q

What are the most frequent indications for lung transplantation?

A
  • Chronic obstructive pulmonary disease
  • Idiopathic pulmonary fibrosis
  • Cystic fibrosis
  • Antitrypsisn deficiency
  • Sarcoidosis
  • Congenital heart disease (Eisenmenger’s syndrome with concomitatnt cardiac repair)
62
Q

Lung transplant stabilizing measure are aimed at improving cardiac output?

A
  • IV inotropes
  • Intra aortic ballon pump
  • Ventricular assist device
  • Mechanical ventilation

Levi's Class 2014 (16 decks)

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