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Cc 12 transplant
Critical Care (408)
Loma Linda University
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Organ Transplant UNOS – United Network for Organ Sharing computerized database national system overseeing organ donations in US private, non-profit organization. all inclusive in operation since 1967 determines who gets the fresh organ in certain criteria
Types of Transplants* autograft transfer of one’s own tissue from one area to the next isograft transplant between genetically identical individuals (identical twins) allograft transplant between genetically different individuals of the same species (both humans) xenograft transplant between different species (baby fae and getting a baboon heart)
solid-organ transplant recipients traveling to foreign countries face greater health risks than their home country ↑ risk of complications from typical travel-related illness risk of opportunistic infections not faced by healthy travelers some vaccines contraindicated after solid-organ transplant save-to-use vaccines may have decreased efficacy drug interactions between antirejection drugs & malaria prophylactic drugs and traveler’s diarrhea drugs
in the US – presumed refusal (have to sign up to be a donor) other nations – presumed consent (have to sign waiver they don’t want to be a donor) wait time varies depending on organ
Donor Organ Procurement living donor liver kidney bone marrow pancreas lung brain dead = “still alive” and kept on life support for the sake of keeping organs alive until it’s ready to be donated deceased donor one donor can give multiple organs
General Donor/Recipient Criteria blood type (ABO) tissue type size don’t want to give wee-man’s donated heart to someone like Shaq patient acuity (how sick they are) Indications for Transplant end stage organ disease (failure) physically capable of surviving transplant too sick to even tolerate the transplant surgery psychosocial functioning adequate for transplant have to be stable to be able to take meds etc. financial means insurance not always going to pay for antirejection meds
Risk/Benefits of Transplantation very specific viewpoint evaluated for each patient because some may reject the organ or more complications occur post- transplant selection committees MD, RN, financial, social work, psychologist, ethicist
Disqualification for Organ Transplant Absolute Contraindication active substance use active infection
Relative Contraindication past medical history HTN – heart/kidney MI cause of current condition
Relative Contraindication – cont. time w/o heartbeat cancer except for brain cancer age older donors for older pts “is it more worth it to give the organ to someone younger or someone older” irreversible organ damage non-adherence to treatment plan unable to undergo rehab
Kidney Transplant Liver Transplant Heart Transplant Pancreas Transplant surgery length: 3- hrs. LOS: 1 week graft survival rate: 88- 94%
surgery length: 8- hrs. LOS: 2 weeks ICU: LOS 2days to 1wk
surgery length: 8- hrs. survival rate: 85% 25% die before donor becomes available for
endocrine vs exocrine functions different types of transplant simultaneous with
graft put in lower anterior abdominal quadrant native kidneys not removed unless medically necessary kidneys stay in body less complications
Kidney Transplant – Complications vascular complications thrombus stenosis urologic complications urinoma formation urine formed in areas outside the urinary system (scrotum or penis in males) rejection recurrent disease diabetes mellitus membranous glomerulonephritis amyloidosis
graft survival rate: 94% longest living – 37 years
Liver Transplant – Complications primary hepatic non- function rejection infection hepatic artery thrombosis portal vein thrombosis biliary tract obstruction recurrent disease
transplant Heart Transplant – Complications rejection coronary artery disease HTN/hyperlipidemia secondary to medication (initially) cyclosporine steroids hyperlipidemia secondary to patient diet (later)
kidney alone after kidney alone pancreas is transplanted into lower anterior abdomen
Organ Rejection* Immunosuppressan t Med
Viral Infection Prevention hyperacute immediate (common in solid organs) right after the transplant or first 1- 2 days acute first 3 months; GVHD chronic anytime but most common after the first year; GVHD
prograf (same time qday) tacrolimus neoral cyclosporin rapamune sirolimus cellcept monosodium mofetiel azothiaprine immuran steroids
because of immunosuppressant therapy they are risk for viral infections prevention: hand washing gancyclovir acyclovir nystatin/mycelex health care provider vaccinations
Transplants – Psych Aspects Transplants – Late Complications
Legal/Ethical Issues*
challenges for patients/families chronic illness patient may still have diabetes even after a pancreas transplant loss of independence complicated medical regimen cost of care/lost income
bone disease cancer – lymphoma (PTLD) Epstein Barr virus d/t immunosuppression other cancers recurrence of disease
required consent advertising for organs proliferation of transplant centers buying organs length of time on waiting list death on waiting lists retransplantation (transplant after rejection) how many times when decision made by the board whether it’s even worth trying again
Cc 12 transplant
Course: Critical Care (408)
University: Loma Linda University
