Organ Transplant - EXAM 5 Flashcards Preview

SEMESTER FOUR!! Nursing 214 > Organ Transplant - EXAM 5 > Flashcards

Flashcards in Organ Transplant - EXAM 5 Deck (27):
1

What is an autologous graft?

An autologous graft is a graft (such as a graft of skin) that is provided for oneself.

2

What is graft-versus-host disease?

  • In bone marrow transplant, immunodeficient patient receives immunocompetent cells
  • GRAFT (donated tissues) rejects HOST (recipient tissues)
  • No risk with autologous or syngeneic (twin) transplant
  • High risk with allogeneic (family member or MUD)
  • Targets the skin, liver, GI tract
  • No adequate treatment once established
  • Primary concern is infection

3

What is brain death?

 

Three Findings:

  1. Coma/unresponsiveness
  2. Apnea
  3. Absent of non-reactive brainstem reflexes
    1. Pupil reflex
    2. Corneal reflex (blinking)
    3. Cough/gag reflex
    4. Response to painful stimuli
    5. Doll's eye and Cold caloric testing

Brain death will lead to cardiac death without ventilation

4

What is cardiac death and what does it mean it terms of transplantation?

Typically when a person suffers a cardiac death, the heart stops beating. The vital organs quickly become unusable for transplantation. But their tissues – such as bone, skin, heart valves and corneas – can be donated within the first 24 hours of death.

  1. Ventilator dependent
  2. Family decision to withdrawl the ventilator
  3. Withdrawal of life-sustaining measure must occur in a controlled setting so organs can be recovered immediately after death to limit ischemic injury

5

What organs can be transplanted?

Heart

Kidneys

Liver

Pancreas

Lungs

Intestine

Can do parings or some. Can do partials of some.

6

What tissues can be transplanted?

Cornea

Skin

Bone Marrow

Heart Valves

Bone

Connective Tissue

7

How does one identify donors?

Donor card

Driver's license

With death/imminent death the next of kin makes decision, even with signed donor card

8

What are the clinical triggers for organ donation that the RN should be alert for?

The RN must know these and refer to Organ Procurement Organization (OPO) within 2 hours of identification

  1. Ventilated patient with poor prognosis
  2. Medically suitable
  3. One of more of the following:
    1. GCS of 5 or less
    2. Loss of 2 or more brainstem reflexes
    3. Initation of brain death testing
    4. Beginning discussion of end-of-life or ventilator withdrawal

9

Why are only ventilated patients eligible donors?

Organs must be perfused and oxygenated until the moment of recovery

Brain death leads to cardiac death without ventilation

10

Who requests the donation from the family?

  • The Organ Procurement Organization (OPO) representative
  • RN/MD or other health care providers are not designated requestors
  • Input of health care team is VITAL to ensure a timely and respectful approach by Donor Recovery Network

11

How is a donor considered eligible?

  1. Labs
  2. Age
  3. Reason for admission
  4. Current medical status
  5. Infectious diseases
  6. Past medical history

12

What is matching and testing?

  1. Human Leukocyte Antigen (HLA) matching: best care scenario is 6/6 match with donor and recipient
  2. ABO matching
  3. Crossmatching right before transplant: + crossmatch means cytotoxic antibodies to donor = transplant contraindicated

13

Who gets the organs?

  1. UNOS (United Network of Organ Sharing) ensures organs are given fairly using an objective point system
  2. Organ offered to recipient with most points in local area (then regional then national)

14

What is recipient point ranking based on?

  1. Matching (HLA/ABO)
  2. Medical urgency
  3. Immune status
  4. Time on waiting list
  5. Geographic location
  6. Age
  7. Body size
  8. Recipient selection is not based on gender, socioeconomic status, celebrity status, and ethnicity/race unless it affects matching

15

What is rejection?

Normal immune response to foreign tissue

16

What is hyperacute rejection?

  1. Immediate
  2. Antigen-antibodies clump in blood vessels, causing blood clots
  3. Treatment: immediate organ removal

17

What is acute rejection?

  1. Happens in the first 6 months after recieving organ
  2. Related to recipient's lymphocytes or antibody development
  3. Occurs in episodes
  4. Usually reversible
  5. Treatment: increased doses of immunosuppresive therapy

18

How is rejection prevented?

  1. Effective matching process
  2. Negative crossmatch right before transplant
  3. Immunosuppresive therapy (antirejection medications)

19

What are the major post-transplant complications?

  1. Rejection
  2. Infection
  3. Malignancies

20

Why is infection a major post-transplant complication?

  1. Related to immunosuppressive therapy
  2. Highest risk in first few months after transplant when doses are highest
  3. Infection control precautions

21

Why are malignancies a major post-transplant?

  1. Related to altered immune system and use of immunosuppresive therapy

22

What are antirejection medications (immunosuppresive therapy)?

  • Delicate balance between preventing rejection and getting overwhelming infection
  • Initially triple therapy reduced over time
  • Try to avoid long term steroid use
  • Must commit to lifelong follow up and medications

23

What are the advantages of immunosuppresive therapy?

  1. Less morbidity/mortality
  2. Much improved transplant sucess and organ survival
  3. Improved quality of life

24

What are the disadvantages of immunosuppresive therapy?

  1. Significant side effects
  2. Malignancy development
  3. Lifelong risk of toxicity

25

What are the issues with organ transplant?

  1. Ethical issues
    1. High disparity between supply and demand
    2. Live donors: risking the health of a well person for someone else
    3. Long wait list: many die while waiting while some go to drastic efforts:
      1. Organ tourism
      2. Underground markets
      3. Organ trafficking

26

What is the role of the nurse in organ transplant?

  1. Advocate for patient
  2. Educator
  3. Counselor
  4. Supporter

27

What are the responsibilites of the nurse in organ transplantation?

  1. Recognize potential donors
  2. Contact OPO (2 hours)
  3. Antcipatory discussions with patient and family
  4. Acknowledge special gift
  5. Private space to grieve
  6. Chaplain/Social workers
  7. Support groups

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