Final organ transplantation [compatibility mode]

ROLE OF NURSE IN ORGAN ROLE OF NURSE IN ORGAN ROLE OF NURSE IN ORGAN ROLE OF NURSE IN ORGAN

DONATION AND CADAVERIC DONATION AND CADAVERIC DONATION AND CADAVERIC DONATION AND CADAVERIC

TRANSPLANTTRANSPLANTTRANSPLANTTRANSPLANT

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

P

rof Dr Joshi S

onopant G M

Sc (N

); M S

c

1

Objectives

• Review organs that are transplantable

• Define types of transplants

• Discuss preoperative preparation of Donor and Recipient

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

and Recipient

• Explain the post operative management of transplant patient

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

2

OVERALL OBJECTIVE OF

TRANSPLANT TEAM

�Transplant recipient will experience

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

�Transplant recipient will experience

an improvement in functional

status, maintain long term graft

function and experiences QOL

3

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

Transplantable Organs/Tissues

• Liver• Kidney• Pancreas• Heart • Lung

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

• Lung• Intestine• Face• Bone Marrow• Cornea• Blood

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

4

WHO CAN BE ORGANS AND TISSUES DONOR

-Brain Stem dead Patient on Mechanical Ventilator-Severe Head Injury patient

-Brain Tumour patient

-Cardio-resparrestpatient

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-Cardio-resparrestpatient

-Anoxia patient

- Non Heart Beating Cadaver Donation

COMMON PROBLEMS

- Cultural reservation

- Ignorance

- Lack of emotional support

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- Lack of emotional support

- Fear of commercialization

- Mistrust of the hospital

PRIORITIES OF DONORS

- Close relatives

- DistantRelatives

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- DistantRelatives

- People from home country

-Strangers

-Cadaveric donors

Types of Transplant

• Heterotopic or Orthotopic

different same

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

• Autograft: same being• Isograft/Syngenetic graft: identical twins• Allograft/homograft: same species• Xenograft/heterograft: between species

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

8

ROLE OF NURSE IN DONATION PROCESS

-Psychological preparation

-Physical preparation

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-Physical preparation

-Long Term follow up

-Life Style Changes

COMPONENT OF NURSINGMGMT

� Early identification of potential donor

� Referal to organ processing organization

� Assisting in medical mgmt of donor

� Psychosocial preparation of donor and recepient

& their families

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

& their families

�Management of client’s vital systems until

donation is completed

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Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

PSYCHOLOGICAL PREPARATION

� Stress Due to

� Declaration of Brain Death

� Termination of Treatment

� Other Critically Ill patients

Intensive hemodynamic monitoring

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

� Intensive hemodynamic monitoring

� To preserve organ viability

� Emotional care of Donor & Family

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Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

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

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

� 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

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

PHYSICAL PREPARATION

PRE-TRANSPLANTATION EVALUATION

� Complete medical history and physical examination

� - Psychiatric and social evaluation � - Laboratory studies

- Electrolyte and metabolic profile

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

� - Electrolyte and metabolic profile � - Liver function test� - Hematologic profile � - Fasting cholesterol/ Lipid profile � - Arterial blood gad analysis � - Urinalysis, urine specific gravity determination 13

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

PRE-TRANSPLANTATION EVALUATION CONT….

- Creatinine clearance determination

- ABO typing

- Antibody screen

- Human leukocyte antigen (HLA) tissue typing

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

- Lymphocyte cytotoxicity screen

- Virology ad microbiologic profile testing for the following:

� Human immunodeficiency virus (HIV)

� Hepatitis B surface antigen (HBsAg)14

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

OTHER CONSIDERATION

� Evaluation usually takes 3-5 days

� Client Education is provided

� Actual waiting time for an organ

� Surgical procedure

� Post transplant regime

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

� Post transplant regime

� Diet, Exercise, Medication, Routine follow up,

Complications and normal life expectations

� Family members counseled

� Psychosocial issues

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Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

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Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

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

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

� 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

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Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

Recipient Qualification

• Most cases <60 yr old

• Disqualified if:

– Recent MI

– Active infection

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

– Active infection

– Malignancy

– Substance abuse

– Limited life expectancy from unrelated disease

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

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PRE-OPERATIVE PERIOD:Living Donor

- Selection and preparation:� Living donors are usually siblings, parents or

children.� Physiology and psychological assessmentof a

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� Physiology and psychological assessmentof apotential donor are done.

� Donor must be in excellent health, well informed andgive informed consent

� There is chance of complications but living donorshave same life expectancy and quality of life

� Compatibility tests are performed in both

� Histocompatibility (tissue typing) studies and bloodtyping are done first

� A donor must have compatible blood type with therecipient and similar tissue type to prevent rejection

If matchingis found and initial testing the donor

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� If matchingis found and initial testing the donorundergoes extensive assessment which includesphysical examination including chest X-ray, urineanalysis, 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 thepatientis onhemodialysispreoperativelyit

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If thepatientis onhemodialysispreoperativelyitis to be carried out within 24 hours prior to surgery,the purpose of which is to correct hyperkalemia andhypervolemia

Infection: Possible site of infection such as lungs,urinary tract and vascular assess site should becarefully treated with appropriate antibiotics.

PRE SURGERY PREPARATION

� General preparation

� Control of infection

� Urine output

� Vital signs

Medical investigations

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

�Medical investigations

� Skin, nose, throat, axilla and groin swabs

� Dialysis if reqd

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Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

POST OPERATIVE NURSING CAREIMMEDIATE CONCERNS: �- Low urine output�- Acute tubular necrosis �- Fluid therapy �- Tests of renal function

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

�- Tests of renal function �- Immunosuppression �- Cyclosporine (Sandimmune) �- Aziathioprine�- Steroids

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Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

POST OPERATIVE NURSING CARE� Potential for Rejection

� Causes

� Impaired Immunocompetence

� Malignancy

� DM

� Hypertension

How to identify Rejection

Progressive enlargement

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

� Progressive enlargement

� Pain

� Tenderness of graft

� High BP

� Diminioshed urine volume

� Raised Creatinin

�Weight gain

� Fever 24

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

� 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

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

�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

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

COMPLICATIONS

� Acute Renal failure

� Bleeding

� Infection

� DM

� Bone marrow Depression

� Vascular Complications

� Liver Failure

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

� Liver Failure

�Myocardial Infarction

� Aseptic Necrosis

� Stress related to rejection

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Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

P

rof Dr Joshi S

onopant G M

Sc (N

); M S

c

27

IMMUNOSUPPRESANTS

� Purpose

� Dose

�When to take

�Missed dose

Precautions

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

� Precautions

� Common side effects

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Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

LAB INVESTIGATIONS

� Regular Follow up is must

� Frequency in 1stMonth - Weekly

� Subsequently – once in a month

� Selection of appropriate Lab

� Collection of lab reports and sending to Surgeon

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

� Collection of lab reports and sending to Surgeon

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Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

DIET THERAPY

� Risk for Imbalanced Nutrition r/t Incresed caloric

needs after transplantation

� To promote wound healing and prevent muscle

loss

� Proteins

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

� Proteins

� Calories

� Vitamins & Minerals

� Limit concentrated sweets and high intake of salt

� Small meals frequently

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Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

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

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

� 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

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

REFERENCES

� Jaya Kuruvilla’s, textbook of “Essentials of Critical CareNursing” Jaypeepublications, New Delhi, 1stedition 2007. Page No. 353-359.

� Joyce M. Black & Jane Hokansons Hawks, textbook of “Medical SurgicalNursing”, 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 & Ireland1(6) 311-322

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

Edinburgh & Ireland1(6) 311-322

� D’Alessandro AM, Hoffman RM, Belzer FO (1995) Non-heart Beating Donors: One Response to the organ shortage Transplantation Reviews9(4) 168-175

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Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

� Lewis DD, Valerius W & Sommerville MA (1998) Non-heart-beating donors: a case study in procurement Journal of Transplant Co-ordination8(4) 218-220

� Edwards JM, Hasz RD & Robertson VM (1999) Non heart beating donation: Process and review Transplantation10(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.

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

� 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.

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Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

Thank YouThank You

Prof D

r Joshi Sonopant G

M S

c (N); M

Sc

(DM

); Ph D

P

rof Dr Joshi S

onopant G M

Sc (N

); M S

c

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