ORGAN TRANSPLANTATION

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ORGAN TRANSPLANTATION
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A sad story about Erik

• Erik, a healthy but reckless 23-year-old male,
  was driving home after a night of partying . he
  had a terrible accident. he ended up in ICU with
  a severe brain injury leaving him brain dead.
  His parents were asked the question...

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Types of Organ Transplants

• Kidney
• Liver
• Heart
• Lung
• Pancreas
• Bone Marrow
• Cornea

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Organ Procurement

• Types of Organ Donors
• Procurement of organ
• 1. Brain death
• 2. Absence of malignancy, sepsis, HIV, organ
  disease
• 3. Proper maintenance
• 4. Safety standards
• Tissue typing of donated organs
• Preservation of organs

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Distribution of Cadaveric Organs

• UNOS - government agency in charge of equitable
  organ distribution.
• CORS State agency
• Distribution to patients on the national list
• Distribution is done based on a point system

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POINT Allocation

• Kidney
• HLA-Histocompatable Lymphocyte Antigens
• 6 perfect
• at least 4-5
• Length of illness
• Urgency
• Age (children priority)
• Location ( local, regional,national)

• Liver
• Blood type ( not HLA)
• Liver size ( estimate donor/recipient weight)
• Age
• Medical Status
• 1-near death
• 2-too ill for discharge
• 3-outpatient/short hospitalization
• 4-home setting

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Making The List for a Kidney

• Recipient Selection Process
• End Stage Renal Disease (ESRD)
• Medical History/Evaluation
• Psychosocial Evaluation

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A sad story about Sharon .with a happy ending ! !

• Sharon is a 43-year-old diabetic with ESRD. She
  has been on the transplant list for 4 years. She
  has become depressed, and is sure she will never
  get a kidney and will die. Then, one evening,
  she gets the phone call...

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Pre-Op Preparation

• teaching
• what to expect tubes, drains, pain
• how to cough, deep breath, cough, splint
• VS monitoring Watch for infection
• will preform bladder capacity testing
• will be dialysed within 24 hours preop
• normalization of body chemistry as much as
  possible

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Kidney Transplant Procedure

• Prepare site for transplanted kidney.
• Establish vascular supply to the transplanted
  kidney
• Establishment of urinary continuity

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Nursing Management after Transplant

• Monitoring Urine Output/ Maintaining Fluid
  Balance
• Monitoring Surgical Complications
• Monitoring Renal Function
• Medications

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Urine output/Fluid management

• Diuresis Phase - replace with IV fluids
• When urine output is low, consider
• - ATN or delayed graft function
• - blood clot blocking urine flow
• -Monitor the electrolytes

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Nursing Management after Transplant

• Monitoring Urine Output/ Maintaining Fluid
  Balance
• Monitoring Surgical Complications
• Monitoring Renal Function
• Medications

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Surgical Complications

• PC hemorrhage
• PC bleeding
• PC hypertension
• PC thrombosis
• PC ureteroneocystostomy leakage

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Nursing Management after Transplant

• Monitoring Urine Output/ Maintaining Fluid
  Balance
• Monitoring Surgical Complications
• Monitoring Renal Function
• Medications

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Monitoring Renal Function

• BUN
• Creatinine
• Biopsy
• PC acute renal rejection
• PC chronic renal rejection

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Symptoms of Rejection

• Acute Rejection
• ? urine output, hypertension, low grade fever
• weight gain, edema, fluid retention
• malaise, chills, ? WBC
• hemuria, proteinuria
• increased serum creatinine level
• Chronic Rejection
• similar to acute- over longer period of time

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Nursing Management after Transplant

• Monitoring Urine Output/ Maintaining Fluid
  Balance
• Monitoring Surgical Complications
• Monitoring Renal Function
• Medications

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Medications

• Immunosupressive Agents
• Anti-infective Agents
• Anti-hypertensive Agents
• Anti-ulcer Agents
• Agents used to treat hyperglycemia

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Immunosuppressive Agents

• Tacrolimus FK 506 (Prograf)
• Cyclosporine (Neoral, Sandimmune)
• Mycophenalte (Cellcept)
• Steroids (Solumederol/Prednisone)
• Azathioprine (Imuran)
• OKT3 (Orthoclone)
• Lymphoctye Immune Globulin ATGAM

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Antiinfective Agents

• Antiviral agents (Acyclovir)
• Antifungal agents (Nystatin)
• Antibacterial agents (Bactrim/Septra)

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Antihypertensive Agents

• Lasix
• Clonidine
• Minipress
• Nifedipine
• Norvasc
• Cardizem

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Other Medications

• Anti-Ulcer (Pepcid)
• Anti-hyperglycemics (insulin, oral agents)
• Anticoagulent (ASA Persantine)

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After the Fact Lots of teaching

• Infection prevention
• Handwashing
• Avoid Crowds
• S and S of infection- early reporting
• Fluid Balance
• how to do, how to monitor
• Meds
• Compliance, schedules,side effect management