Final organ transplantation [compatibility mode]

ROLE OF NURSE IN ORGANROLE OF NURSE IN ORGANROLE OF NURSE IN ORGANROLE OF NURSE IN ORGAN
DONATION AND CADAVERICDONATION AND CADAVERICDONATION AND CADAVERICDONATION AND CADAVERIC
TRANSPLANTTRANSPLANTTRANSPLANTTRANSPLANT
ProfDrJoshiSonopantGMSc(N);MSc
(DM);PhD
1

Objectives
• Review organs that are transplantable
• Define types of transplants
• Discuss preoperative preparation of Donor
and Recipient
(DM);PhD
and Recipient
• Explain the post operative management of
transplant patient
2

OVERALL OBJECTIVE OF
TRANSPLANT TEAM
Transplant recipient will experience
(DM);PhD
Transplant recipient will experience
an improvement in functional
status, maintain long term graft
function and experiences QOL
3

Transplantable Organs/Tissues
• Liver
• Kidney
• Pancreas
• Heart
• Lung
(DM);PhD
• Lung
• Intestine
• Face
• Bone Marrow
• Cornea
• Blood
4

WHO CAN BE ORGANS AND TISSUES DONOR
-Brain Stem dead Patient on Mechanical Ventilator
-Severe Head Injury patient
-Brain Tumour patient
-Cardio-resp arrest patient
5
-Cardio-resp arrest patient
-Anoxia patient
- Non Heart Beating Cadaver Donation

COMMON PROBLEMS
- Cultural reservation
- Ignorance
- Lack of emotional support
6
- Lack of emotional support
- Fear of commercialization
- Mistrust of the hospital

PRIORITIES OF DONORS
- Close relatives
- Distant Relatives
7
- Distant Relatives
- People from home country
-Strangers
-Cadaveric donors

Types of Transplant
• Heterotopic or Orthotopic
different same
(DM);PhD
• Autograft: same being
• Isograft/Syngenetic graft: identical twins
• Allograft/homograft: same species
• Xenograft/heterograft: between species
8

ROLE OF NURSE IN DONATION PROCESS
-Psychological preparation
-Physical preparation
9
-Physical preparation
-Long Term follow up
-Life Style Changes

COMPONENT OF NURSING MGMT
Early identification of potential donor
Referal to organ processing organization
Assisting in medical mgmt of donor
Psychosocial preparation of donor and recepient
& their families
(DM);PhD
& their families
Management of client’s vital systems until
donation is completed
10

PSYCHOLOGICAL PREPARATION
Stress Due to
Declaration of Brain Death
Termination of Treatment
Other Critically Ill patients
Intensive hemodynamic monitoring
(DM);PhD
Intensive hemodynamic monitoring
To preserve organ viability
Emotional care of Donor & Family
11

PSYCHOLOGICAL PREPARATION OF PT
Patient may present – Denial, guilt, depression,
regression and resentment, Hopes are altered
Nurses discuss with patient & their families reg.
feelings
Build positive relationship with patient
(DM);PhD
Build positive relationship with patient
Assist them to adapt and cope with treatment
Patient await for organ donor – experience
feeling of anxiety, fear of unknown, long term
health problem, body image changes
Assess patient’s coping abilities
Assess patient’s support system, family members,
friends, counselors 12

PHYSICAL PREPARATION
PRE-TRANSPLANTATION EVALUATION
Complete medical history and physical
examination
- Psychiatric and social evaluation
- Laboratory studies
- Electrolyte and metabolic profile
(DM);PhD
- Electrolyte and metabolic profile
- Liver function test
- Hematologic profile
- Fasting cholesterol/ Lipid profile
- Arterial blood gad analysis
- Urinalysis, urine specific gravity determination 13

PRE-TRANSPLANTATION EVALUATION CONT….
- Creatinine clearance determination
- ABO typing
- Antibody screen
- Human leukocyte antigen (HLA) tissue typing
(DM);PhD
- Lymphocyte cytotoxicity screen
- Virology ad microbiologic profile testing for the
following:
Human immunodeficiency virus (HIV)
Hepatitis B surface antigen (HBsAg)
14

OTHER CONSIDERATION
Evaluation usually takes 3-5 days
Client Education is provided
Actual waiting time for an organ
Surgical procedure
Post transplant regime
(DM);PhD
Post transplant regime
Diet, Exercise, Medication, Routine follow up,
Complications and normal life expectations
Family members counseled
Psychosocial issues
15

(DM);PhD
16

EDUCATIONAL PREPARATION
Objective
To increase competence and confidence of patient for
self management.
To prepare patient and families for independence
Explanation to pt reg immunosupressive drugs
(DM);PhD
Explanation to pt reg immunosupressive drugs
Good communication and assess learning need of
pt
Use DVD, Leaflets internet sites, meeting the
transplant patients who have undergone
transplant
17

Recipient Qualification
• Most cases <60 yr old
• Disqualified if:
– Recent MI
– Active infection
(DM);PhD
– Active infection
– Malignancy
– Substance abuse
– Limited life expectancy from unrelated disease
18

PRE-OPERATIVE PERIOD:
Living Donor
- Selection and preparation:
Living donors are usually siblings, parents or
children.
Physiology and psychological assessment of a
19
Physiology and psychological assessment of a
potential donor are done.
Donor must be in excellent health, well informed and
give informed consent
There is chance of complications but living donors
have same life expectancy and quality of life
Compatibility tests are performed in both

Histocompatibility (tissue typing) studies and blood
typing are done first
A donor must have compatible blood type with the
recipient and similar tissue type to prevent rejection
If matching is found and initial testing the donor
20
If matching is found and initial testing the donor
undergoes extensive assessment which includes
physical examination including chest X-ray, urine
analysis, urine culture, intravenous pyelogram,
CBC, Electrolyte studies, glucose tolerance test,
BUN, serum creatinine, creatinine clearance,
aortagram and renal arteriogram

- Cadaver donors
- Recipient selection and preparation
- PRE-OPERATIVE DIALYSIS-
If the patient is on hemodialysis preoperatively it
21
If the patient is on hemodialysis preoperatively it
is to be carried out within 24 hours prior to surgery,
the purpose of which is to correct hyperkalemia and
hypervolemia
Infection: Possible site of infection such as lungs,
urinary tract and vascular assess site should be
carefully treated with appropriate antibiotics.

PRE SURGERY PREPARATION
General preparation
Control of infection
Urine output
Vital signs
Medical investigations
(DM);PhD
Medical investigations
Skin, nose, throat, axilla and groin swabs
Dialysis if reqd
22

POST OPERATIVE NURSING CARE
IMMEDIATE CONCERNS:
- Low urine output
- Acute tubular necrosis
- Fluid therapy
- Tests of renal function
(DM);PhD
- Tests of renal function
- Immunosuppression
- Cyclosporine (Sandimmune)
- Aziathioprine
- Steroids
23

POST OPERATIVE NURSING CARE
Potential for Rejection
Causes
Impaired Immunocompetence
Malignancy
DM
Hypertension
How to identify Rejection
Progressive enlargement
(DM);PhD
Progressive enlargement
Pain
Tenderness of graft
High BP
Diminioshed urine volume
Raised Creatinin
Weight gain
Fever
24

Potential For Infection
Protective Isolation
Use all protective equipments while caring
Immunisuppresive drugs
Strict Aseptic precautions
Change dressings promptly
Frequent bacteriological test of urine and exit wounds
Monitor vascular access
(DM);PhD
Monitor vascular access
Oral mycostatin mouth wash
Restrict fluid intake 600 ml/24 hrs
Monitor CVP, ECG & skin temp
Strict intake output chart
Measure urine every 1 hr
Palpate bladder for distention 25

COMPLICATIONS
Acute Renal failure
Bleeding
Infection
DM
Bone marrow Depression
Vascular Complications
Liver Failure
(DM);PhD
Liver Failure
Myocardial Infarction
Aseptic Necrosis
Stress related to rejection
26

(DM);PhD
27

IMMUNOSUPPRESANTS
Purpose
Dose
When to take
Missed dose
Precautions
(DM);PhD
Precautions
Common side effects
28

LAB INVESTIGATIONS
Regular Follow up is must
Frequency in 1st Month - Weekly
Subsequently – once in a month
Selection of appropriate Lab
Collection of lab reports and sending to Surgeon
(DM);PhD
Collection of lab reports and sending to Surgeon
29

DIET THERAPY
Risk for Imbalanced Nutrition r/t Incresed caloric
needs after transplantation
To promote wound healing and prevent muscle
loss
Proteins
(DM);PhD
Proteins
Calories
Vitamins & Minerals
Limit concentrated sweets and high intake of salt
Small meals frequently
30

LIFE STYLE CHANGES
Progressive exercise as per experts advice
Warning signs of skin cancers are any sores
that bleed, scab, grow, or do not go away
in a few weeks .
Prevention of Infection – Protect yourself from
(DM);PhD
Prevention of Infection – Protect yourself from
Infection as Immune System is suppresed
Routine Dental care at least once in 6 months
Infection
Bleeding Gums
Regular Cleaning and Inspection
No Smoking, Alcohol or Drugs 31

REFERENCES
Jaya Kuruvilla’s, textbook of “Essentials of Critical Care Nursing” Jaypee
publications, New Delhi, 1stedition 2007. Page No. 353-359.
Joyce M. Black & Jane Hokansons Hawks, textbook of “Medical Surgical
Nursing”, Elsevier’s publications,New Delhi, 8th edition, reprinted 2012.
Page No. 2137-2141.
Brook NR & Nicholson ML (2003) Kidney transplantation from non-heart
beating donors. The Surgeon:Journal of the Royal Colleges of Surgeons of
Edinburgh & Ireland 1(6) 311-322
(DM);PhD
Edinburgh & Ireland 1(6) 311-322
D’Alessandro AM, Hoffman RM, Belzer FO (1995) Non-heart Beating
Donors: One Response to the organ shortage Transplantation Reviews 9(4)
168-175
32

Lewis DD, Valerius W & Sommerville MA (1998) Non-heart-beating
donors: a case study in procurement Journal of Transplant Co-ordination
8(4) 218-220
Edwards JM, Hasz RD & Robertson VM (1999) Non heart beating
donation: Process and review Transplantation 10(2) 293-300
National Institute of Allergy and Infectious Diseases. Available at:
http://www3.niaid.nih.gov/topics/transplant/history. Accessed January 12,
2009.
Sade RM. Transplantation at 100 Years: Alexis Carrel, Pioneer Surgeon.
(DM);PhD
Sade RM. Transplantation at 100 Years: Alexis Carrel, Pioneer Surgeon.
Ann Thorac Surg. 2005;80:2415-8.
United Network for Organ Sharing. Available at: http://www.unos.org.
Accessed January 12, 2009.
Lindenfeld J, Miller GG, Shakar SF, Zolty R, Lowes BD, Wolfel EE,
Mestroni L, Page RL, Kobashigawa J. Drug Therapy in the Heart
Transplant Recipient: Part II: Immunosuppressive Drugs. Circulation.
2004;110:3858-3865.
33

Thank YouThank You
(DM);PhD
34

Final organ transplantation [compatibility mode]

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