Organ Donation Flashcards
(42 cards)
1
Q
Describe the waiting list process for organ transplants?
A
- get a referral
- gather information
- select transplant center
- schedule an evaluation appointment
- get on the list
2
Q
What factors are considered when deciding to allocate an organ?
A
- ABO blood typing
- tissue typing
- size
- waiting time
- severity of illness/degree of medical urgency
- geographic location
3
Q
What are the criteria for an organ transplant?
A
- presence of end stage disease in a transplantable organ
- failure of conventional therapy to treat the condition successfully
- absence of untreatable malignancy/irreversible infection
- absence of a disease that would attack the transplanted organ/tissue
4
Q
What are the characteristics of transplant candidates?
A
- demonstrate emotional and psychological stability
- have an adequate support system
- be willing to comply with lifelong immunosuppressive drug therapy
- *age limits, criteria of substance abuse are specific to transplant facility**
5
Q
Where do organs come from?
A
- cadavers
- living donors
6
Q
What are some listed preoperative issues?
A
- weakness
- prolonged hospitalization
- fatigue
- extended confinement to bed/home
- poor functional mobility including gait
- poor breathing mechanics
- poor airway clearance
- poor endurance
- balance deficits
- fall risk
- loss of ROM
- loss of functional independence
- skin breakdown
- dyspnea
- pain
- edema
7
Q
What are the pre-transplant hospitalizations for liver failure?
A
hepatic infections
8
Q
What are the pre-transplant hospitalizations for kidney failure?
A
- dehydration
- DM complications
9
Q
What are the pre-transplant hospitalizations for pancreatic failure?
A
complications from DM
10
Q
What are the pre-transplant hospitalizations for intestinal failure?
A
- bowel obstructions
- symptom of liver failure
11
Q
What are the pre-transplant hospitalizations for heart failure?
A
- ischemic and non-ischemic causes
12
Q
What are the pre-transplant hospitalizations for lung failure?
A
- infection
- COPD exacerbation
13
Q
What is the typical post-op care for a donor?
A
- take off mech vent in recovery room and transferred to general surgery/transplant ward
- VS and CBC monitored for SxS of post-op bleeding
- pts OOB and ambulating by POD1
- avg duration of hospitalization ranges from 1-2 days (kidney) to 8 days (simultaneous pancreas-kidney)
- PT is only involved in instances of complications
14
Q
What is typical post-op care for a recipient?
A
focus on:
- allograft function
- rejection
- infection
- AE of immunosuppressants
- complications related to surgical/medical rejection, infection
15
Q
What are the complications that may occur following an organ transplantation?
A
- rejection
- infection
16
Q
Describe a transplant rejection
A
the leading problem of organ transplant
- requires lifelong immunosuppressant drugs
- delicate balance between suppressing organ rejection and life-threatening suppression of immune function
17
Q
What are the general SxS of a transplant rejection?
A
- flu-like symptoms
- fever > 101
- pain over transplant
- fatigue
- specific to organ
18
Q
What are the approaches to post-transplant management?
A
- induction immunosuppression
- maintenance immunosuppression
- anti-rejection immunosuppression
19
Q
What are the types of graft rejections?
A
- hyperacute
- acute
- chronic
20
Q
Describe hyperacute graft rejection
A
- occurs within 48hrs of transplant surgery
- graft becomes non-functional within hours/days
- usually due to ABO blood group of HLA typing
- usually unresponsive to tx
- requires removal of transplant and subsequent re-transplantation
21
Q
Describe acute graft rejection
A
- an adaptive response involving T cells, mediated by CD8 cells, CD4 cells, or both
- may occur within 3mo - 1 yr post-transplant
- treatable but requires early intervention
- anti-rejection drugs used
22
Q
What may decrease the likelihood of an acute graft rejection?
A
- verifying ABO compatibility
- crossmatching between donor and recipient
- HLA matching
23
Q
Describe chronic graft rejection
A
- most likely an antibody mediated process involving T and B lymphocytes
- occurs within a few months post-op
- gradual and progressive deterioration of the graft
- retransplantation will eventually be required
24
Q
What may occur with chronic rejection in the lungs?
A
bronchiolitis obliterans
25
What may occur with chronic rejection in the heart?
cardiac transplant vasculopathy
26
What may occur with chronic rejection in the kidney?
transplant nephropathy/glomerulopathy
27
What may occur with chronic rejection in the liver?
- ductopenic rejection
| - vanishing bile duct syndrome
28
Describe Acute Graft vs Host Disease (Acute GVHD)
the donor organ rejects the recipient body
- causes tissue destruction via immune response
- causes a cytokine storm
- contributes to post-transplant mortality in 15-40% of pts
29
What are the symptoms of Acute GVHD?
- hepatitis
- dermatitis
- GI issues
30
Describe Chronic Graft vs Host Disease (Chronic GVHD)
- multiple organ toxicity
- develops in 15-50% of pts who survive 3months post-transplant
- involves integumentary, ocular, GI, and a range of other organ dysfunction
31
What are the general symptoms of GVHD?
- abdominal pain
- NVD
- skin rash
- specific to organ
32
What is a pt at increased risk for following an organ transplant?
increased susceptibility to bacterial, fungal, and viral infections
33
What is infection following transplant the leading cause of?
- critical illness
- hospitalization
- morbidity
- mortality
34
What is given prophylactically to prevent infection following transplant?
- antivirals
- antibacterials
- antifungals
35
What are the SxS of infection following a transplant?
- temperature > 100.5F
- fatigue
- shaking
- chills
- body aches
- sweating
- diarrhea > 2 days
- dyspnea
- cough/sore throat
36
What are typical PT guidelines for LOS?
typically 3-16 days but depends on the type of transplant
- shortest: kidney
- longest: simultaneous pancreas kidney
37
What are some reasons that transplant recipients are often deconditioned/in poor health going into surgery?
- lengthened recovery time due to pre-op deficits
- generalized weakness from disease process
- liver transplant: extreme weakness/fatigue
- heart/lung transplants: decreased O2 capacity
38
What should PT be aware of following a transplant?
- PT is safe as long as the pt is stable
- be aware of GVHD SxS
- be aware of organ rejection SxS
- coordinate the best time to tx pt based on meds and fatigue level
39
What MAP ensures adequate organ perfusion?
>60-70mmHg
40
What interventions will PT be most focused on following transplant?
- gas exchange
- airway clearance
- positioning
- therex
- transfer training
- gait training
41
What are some additional PT guidelines for post-op transplant?
- infection control
- mobilization (early, encourage ambulation, less complicated : within 1-2 days)
- appropriate activity modification
- continuously monitor VS
- exercise may continue if rejection is mild-mod
- be aware of immunosuppressive agent effects
- consider appropriate outcome measures
- pts will fatigue easily and require frequent rest breaks
42
What are important parts of patient education for this population?
- pre-op expectations
- customized HEP
- avoid strenuous exercise that puts stress on the incision site for 2 months post-op
- no contact sports (for life) following transplant
