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Organ Donation & Transplantation Cheat Sheet by

Adult Health 2
nursing     care     health     adult     critical

Candidates

Who is a candi­dat­e?
Free of medical problems that would increase risk
- Will NOT take if: advanced/ uncorr­ected (cardiac) disease, cancer, psych issues, multiple organ involv­ement
Who is a donor?
Healthy, no infect­ion­/sy­stemic disease
May donate diseased organs (hepat­itis)
Living, NHBB, cadavers
No signif­icant cancer history
No history of kidney diseas­e/a­dequate kidney function
Comp­ati­ble?
Human Leukocyte Antigen (HLA)
Same blood type, tissue type
Kidney: ages 2-70
Heart: <65yo, <1 yr to live, stages 3 & 4 HF

Factors to Consider

Tissue typing & blood typing
Body size
Geography

Pre-Op

Extensive evaluation process - tissue typing
Health teaching - ready to take care of themse­lves?
Kidney transp­lant: dialysis after, may receive blood transf­usion before

Post-Op

Expected clinical findings & potential compli­cations MUST be antici­pated by the nurse!
 

Stages of Rejection

1. Hyperacute (& Accele­rated)
2. Acute
3. Chronic

Hyperacute Rejection

1st 48 hours - WORST
Recipient has antibody to donor transp­lant, not known before
Risk factors: previous transp­lant, different blood type
Clotting cascade vascular damage graft necrosis
A sure sign of graft failure
Symptoms: inc. BP & pain at site
Preven­tion:
- Matching HLA
- Start anti-r­eje­ction meds ASAP

Accele­rated Rejection

Within 1 week - 3 months
Variation of hyperacute
- Body makes lesser amount of antibodies
Specific to kidneys
Symptoms: anuria, inc. BUN & creat., pain

Acute Rejection

Within 3 months - MOST COMMON
Responds best to - immu­nos­upp­ressive therapy
Symptoms:
- Dec. urine/­anu­ria
- Temp. > 100oF
- Inc. BP
- Inc. BUN & creat.
 

Chronic Rejection

3 months - 1 year
Most likely a combin­ation of cell-m­ediated responses to circul­ating antibodies
Symptoms:
- Inc. BUN & creat.
- Fati­gue
- Elec­trolyte imbala­nces
Treated conser­vat­ively

Other Compli­cations

Infe­ction - AMS, low-grade fevers, opport­unistic infections
Blee­ding
Hema­tom­as/­abs­ces­ses &
fluid accumu­lation = wound compli­cations
Urinary tract compli­cat­ions

Mainte­nance Drug Therapy

Combin­ation of...
IMMU­NOS­UPP­RES­SANTS & STEROIDS
Cycl­osp­orine (Gengraf & Sandim­mun­e): stops the production of IL-2, which prevents activation of lympho­cytes involved in transplant rejection
Anti­-pr­oli­fer­ati­ves: inhibit something essential to DNA synthesis, preventing cell divisi­on/­act­ivating lympho­cytes
- Imuran (Azath­iop­rine)
- Cellcept (Mycop­hen­ola­te)
- Prograf (Tacro­lim­us)
- Rapamune (Sirol­imus)
Risk of... leukop­enia, thromb­ocy­top­enia, opport­unistic infection
Mono­clonal antibo­dies: target activation sites of T-lymp­hoc­ytes, increasing their elimin­ation
- Orth­oclone (OKT3)
- Zenapax (Dacli­zum­ab)
Risk of... SIRS, developing malign­ancies
Poly­clonal antibo­dies: derived from other animals, bind to and eliminate most T-lymp­hoc­ytes, stopping rejection
- Atgam (Antit­hym­ocyte globul­in)

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