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N934 Advanced Principles of Anesthesia II > Organ Donation > Flashcards

Organ Donation Flashcards

(54 cards)

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1
Q

Organ Procurement and Transplantation Network (OPTN)

A
  • established by congress in 1984
  • facilitates organ matching/allocation process
  • collects and manages data about organ donation and transplantation
  • professional and public education
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2
Q

United Network for Organ Sharing (UNOS)

A
  • administers the OPTN under contract with health resources and services admin of the US department of health and human services
  • develop policy
  • monitor and enforce processes of OPTN
  • maintain OPTN membership and review application
  • organ transplant centers HAVE to be members of this
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3
Q

organ most transplanted as of 2020

A

kidney

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4
Q

organs transplanted from most to least frequent

A
  • kidney
  • liver
  • pancreas
  • kidney/pancreas
  • heart
  • lung
  • heart/lung
  • intestine
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5
Q

current waiting list for all organs

A

117,204

demand is HIGH

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6
Q

allograft/homograft

A

-tissue for transplant derived from a non-twin donor of the same species

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7
Q

autograft

A
  • tissue for transplant derived from the recipient

- example = burn patient skin graft

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8
Q

orthotopic

A

-implanting an organ in the anatomic position after the native organ is removed

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9
Q

heterotopic

A

-implanting an organ leaving the native organ in place

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10
Q

xenograft/heterograft

A
  • tissue grafted from one species to another
  • example is using pig valve for valve replacements
  • also some full organ transplant from animal to human
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11
Q

Major Histocompatibility Complex (MHC) antigens

A
  • cell surface glycoproteins that establish immunologic identity
  • class I human leukocyte antigen (HLA) A-B-C classic transplant antigens
  • class II HLA DR-DQ-DP on activated t cells are antibodies that will attack foreign objects
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12
Q

major blood group antigens

A

ABO potent transplant antigens

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13
Q

Kidney HLA tissue typing

A
  • ABO and HLA matching, T-Cell cross match and PRA (panel reactive antibody profile)
  • also pancreas and ideally lung (but sometimes not lung because time is of the essence)
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14
Q

heart/liver HLA tissue typing

A

-ABO and other factors such as size/urgency

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15
Q

types of organ donors

A
  • cadaveric; donation after brain death (DBD)
  • non-heart beating donor; donation after cardiac death (DCD)
  • living donor - kidney paired donation (sometimes liver too)
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16
Q

cadaveric or donation after brain death

A
  • previously healthy
  • brain death established
  • negative for extracranial malignancy
  • absence of untreatable infection
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17
Q

donor mechanism of injury in DBD

A

usually violent in some way - MVC, GSW, asphyxiation

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18
Q

determination of brain death history

A
  • first talked about in mid 1950s
  • Harvard med school published criteria for brain death in 1968 because this is when 1st heart transplant occurred
  • president commission for the study of ethical problems in medicine 1981; defined brain as primary organ
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19
Q

what must be done to determine brain death

A
  • r/o reversible cerebral dysfunction
  • nothing else that could be masking as brain death
  • hypothermia
  • hypotension
  • metabolic/endocrine instability
  • drug OD
  • R/O and like that for 12-14 hours then can proceed with brain death testing
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20
Q

criteria on brain death exam

A
  • comatose - unresponsive to verbal stimuli
  • absence of cerebral cortical function - non-responsive to painful stimulus; absence of spontaneous movement
  • loss of brain stem function - reflexes
  • supporting studies - EEG and cerebral flow studies; sometimes HAVE to do this
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21
Q

neurological absence of brain stem function (also part of brain death exam)

A
  • pupillary response to light
  • corneal reflex
  • oculocephalic reflex absent, dolls eye response
  • oculovestibular reflex absent, cold caloric test
  • gag and cough reflex
  • absent respiratory reflex (apnea test)
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22
Q

occulcephalic reflex absent

Study These Flashcards
A
  • eyes fixed when head rotated sideways - BAD

- normal for eyes to move the opposite way

23
Q

oculovestibular reflex absent

Study These Flashcards
A
  • irrigate ear with cold water

- eyes have nystagmus toward stimulated ear

24
Q

apnea test

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A
  • 100% FiO2 for 10 min
  • normalized PaCO2 - confirmed by ABG
  • T-piece for 7-10 minutes
  • repeat ABG
  • PaCO2 on repeat > 60 mmHg
  • absence of spontaneous ventilation
  • sometimes unable to complete due to patient stability - may need EEG or flow study
25
non-heart beating organ donor (or donation after cardiac death)
- S/P cardiac arrest - death anticipated within 1-2 hours (ideally sooner) after life support withdrawn - comatose, unresponsive; may have some brainstem activity but poor quality of life - warm ischemia time - controlled vs uncontrolled
26
kidney living organ donor
- donor is usually healthy - advantages = decreased cold ischemic time (organ will work better) and less time on waiting list - can be laparoscopic or open - selection of kidney = usually of L side bc easier to get to and longer vascular access - anesthetic = GA; standard monitors; maintain UOP with mannitol/lasix; heparin and protamine prior to clamping
27
partial liver living organ donor
- more common in peds vs adults - not done as much anymore - liver regenerates over time - adult usually R side = V, VI, VII, VIII - peds usually L side = II, III, IV - anesthetic technique is GA - monitoring - CVP, A line, Large bore IV - +/- epidural (controversial in literature) - drop CVP with transection to around 5 mmHg or less - NGT FO SURE!!! to evacuate the stomach - no N2O, dont want bowel expansion - cell saver or isovolemic hemodilution - clamp hepatic --> VR decrease 20% (good to volume load before this)
28
organ preservation strategies
- keep organ healthy so it will work for the recipient - hypothermia decrease metabolism - maintain cellular integrity - prevent cellular swelling, vasospasm and build up of toxic metabolism - provide source of energy
29
Ex-vivo organ preservation
- rapid cooling at 4 degrees celcius - preservative solutions - removed in order of susceptibility
30
preservative solutions
- UW - intrabdominal organs (hyperkalemia) | - celsior/cardioplegia (heart)
31
order of susceptibility of removal
- heart - lung - liver - kidney
32
heart max preservation time
4-6 hours
33
liver max preservation time
8-12 hours | *Barash used to say up to 24 hours
34
pancreas max preservation time
12-18 hours
35
kidney max preservation time
24-36 horus
36
donor anesthesia
- brain death = established prior to arrival in OR - goal = preserve organ perfusion and oxygenation - hypotension - loss of descending vasomotor control - decreased CO and SVR - decreased oxygenation = atelectasis, aspiration, pulmonary edema - DI = destruction of hypothalamic-pituitary axis - bradycardia = loss of vagal motor nucleus, increased ICP - visceral and somatic reflexes = will still have these
37
visceral and somatic reflexes
- still present after brain death - donor can still respond to pain and have some motor movements - may need opioids and muscle relaxant
38
MAP for preserving organ function
60-100 mmHg
39
UOP for preserving organ function
0.5-3 mL/kg/hr
40
Hgb for preserving organ function
>10 g/dL
41
Glucose for preserving organ function
120-180 mg/dL
42
CVP for preserving organ function
5-10 mmHg
43
FiO2 for preserving organ function
<40% if tolerated for lung retrieval especially to minimize effects of O2 toxicity
44
PEEP for preserving organ function
no more than 10 cm H2O; now more liberal though
45
SaO2 for preserving organ function
>95%
46
PaO2 for preserving organ function
>100 mmHg
47
Core temp for preserving organ function
> 35 C
48
fluids for organ donation
colloids first vs crystalloid, especially for lungs
49
vasopressors in order of use
dopamine vasopresson (recommended for heart) dobutamine epinephrine
50
which vasopressor do you NOT use
phenylephrine; decreases splanchnic BF which is BAD for abdominal perfusion if those organs are being procured
51
bradycardia for organ donation
- resistant to atropine because no vasomotor control | - use a direct acting agent like isoproterenol
52
DI in organ donation
- vasopressin or DDAVP | - free water - D5W 0.45% NS = fluid type based on hourly serum electrolytes
53
other things for donor anesthesia
- standard monitors, A line, CVP, Swan - pressors and SNP/NTG/beta blocker - PRBCs/FFB - Heparin - mannitol/lasix - methylprednisolone (protects heart, lungs and kidneys from ischemia) - PGE1 (lung membrane stabilization) - long acting NDMR
54
special considerations for donor anesthesia
- confirm ETT placement with surgical team - midline incision from neck to pubis - ensure you know organs that are to be procured - sternal saw --> drop lungs - organs mobilized and dissected - aorta cross-clamped and vent turned off - heart lung procurement --> continue to manually ventilate at 4 breaths/min

N934 Advanced Principles of Anesthesia II (17 decks)

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