Surgery: Transplant

Question 1

what was the first transplant and when was it?

Answer 1

1869- skin graft

Question 2

what year did Congress passes the Uniform Anatomical Gift Act? what is this?

Answer 2

1968 makes donating organs and tissues legal

Question 3

Organ Procurement and Transplantation Network: what does it do?

Answer 3

to ensure fair and equitable allocation of donated organ and tissues.

Question 4

United Network for Organ Sharing (UNOS): what does it do?

Answer 4

provides services for equitable access and allocation of organs and sets the membership criteria and standards for transplant centers in the U.S.

Question 5

what is brain death? how is it diagnosed?

Answer 5

total cessation of brain function, including brain stem function
*its a clinical diagnosis

Question 6

clinical neuro findings of brain death (7)

Answer 6

1) . Absence of Pupillary Response (fixed and dilated, mid position pupils between 4-6 mm)
2) . Doll’s eye- oculocephalic testing
3) . Absent corneal reflex
4) . absent painful stimuli (i.e. nailbed pressure)
5) . absent sucking and rooting reflex
6) . absent gag and cough reflex when bronchial suctioning
7) . absent jaw reflex

Question 7

positive apnea test numbers (weeds?)

Answer 7

Positive Apnea Test if PaCO2 > 60 mm Hg or > 20 mm Hg from Baseline ABG

Question 8

brain death: two confirmatory Dx tests

Answer 8

1. CT scan: diffuse brain edema
2. cerebral angiogram: No intracerebral filling at the level of the carotid bifurcation or Circle of Willis = Empty “ Champagne Glass sign”

Question 9

what is donation after cardiac death (DCD)? (KNOW)

Answer 9

Patient can’t be declared dead based on brain function
SO… patient is declared dead upon cardiac death, which is the cessation of cardiac and respiratory function when the patient is withdrawn from life support.
*Family requests removal of Life sustaining processes.

Question 10

DCD timing

Answer 10

Cardiopulmonary Arrest must occur within 90 minutes of withdrawal
– > If no arrest in 90 minutes, patient will be transferred to a non-ICU bed

Question 11

donor designation VA law

Answer 11

Virginia law requires the donor’s advance directive to be honored (like on your drivers license)

Question 12

Goals of donor management (what do we want for a viable organ)? weeds maybe?

Answer 12

1. Oxygenation: PaO2 > 100 mmHg
2. Hydration and Perfusion
3. Normothermia
4. Asepsis
5. Normalized lab values

Question 13

of the “goals for donor mgmt” which is the most important determinant of organ viability ?

Answer 13

hydration and perfusion:

Optimal organ perfusion occurs at systolic pressures > 100 mmHg

Question 14

autograft vs isograft

Answer 14

Autograft – Same individual is both donor and recipient e.g. Blood Donation
Isograft – Donor and recipient are genetically identical e.g. Twins

Question 15

allograft vs xenograft

Answer 15

Allograft – Donor and recipient are genetically dissimilar, but of the same species e.g. Organ Transplant
Xenograft – Donor and recipient belong to different species e.g. Pig Heart Valve

Question 16

orthotopic vs heterotopic vs paratopic

Answer 16

Orthotopic – Donor Organ is placed in normal anatomic position e.g. Liver, Heart
Heterotopic – Donor organ is placed in a different site than the normal anatomic position e.g. Kidney is placed at the Iliac artery/vein
Paratopic – Donor organ is placed close to the original organ

Question 17

4 meds for transplant recipient- to prevent rejection (KNOW)

Answer 17

1) . Immunosuppression- methylprednisone (most common, cyclosporine, azathioprine, Cellcept, etc
2) . antiviral- valcyte (CMV, EBV)
3) Abx - bactrim DS
4) . antifungal- diflucan

Question 18

4 types of transplant rejection (KNOW)

Answer 18

1. hyperacute: immediate in the OR (remove organ immediately)
2. accelerated acute: 7-10 post-op (via donor antigen- memory Tcells)
3. acute: up to 6 months post-op
4. chronic: months-years post-op

Question 19

what are three things that could prevent someone from being a donor? (KNOW)

Answer 19

1) . active viral infections: if HIV+ (unless recipient says its ok), HBV, HCV, HSV, CMV
2) . systemic infection
3) . cancer (except low grade skin CA, primary brain tumors, and low grade solid organ tumor with >5yr tumor free interval)

Question 20

three main donor types (KNOW)

Answer 20

1) . living donation
2) . donation after brain death
3) . donation after cardiac death

Question 21

types of living donation (KNOW)

Answer 21

kidney or parts of liver

Question 22

what can be donated from a brain death pt? (KNOW)

Answer 22

considered a Full Organ and Tissue Donor

*these patients save 7-8 peoples lives and can enhance another 50 individuals through Tissue donation

Question 23

what can be donated by a DCD pt? (KNOW)

Answer 23

kidney, liver, tissues (abdominal organs ONLY)