Brain death
the irreversible cessation of all functions of the entire brain, including the brain stem.
*
DIFFERENT FROM VEGETATIVE STATE, ANENCEPHALIC INFANTS, AND IRREVERSIBLE COMA, some brain function remains intact here
*
Brain death criteria:
1.Absence of spontaneous respirations
2. No spontaneous movements
3. No corneal reflexes
4. No gag or cough reflexes
5. Negative doll's eyes
6. No response to ice calories
7. isoelectric electroencephalogram
*
may also do a flow test to see if blood is fl
What organs can be donated in the case of brain death?
1. heart
2. liver
3. lungs
4. kidneys
5. pancreas
6. small bowel (not always)
What happens when a person is a donor and pronounced with brain death?
1. the pt is pronounced dead
2. perfusion and oxygenation is maintained, until the organs can be removed in the OR.
3. Organs must be removed and transplanted quickly.
Cardiopulmonary criteria for death
1. irreversible cessation of circulatory and respiratory function.
2. the decision to withdraw care must be made seperately from the decision to donate organs, and organ donation CANNOT be the cause of death.
*
MOST COMMON
*
When do you call the donation lines for cardiac death?
WITHIN 60 MINS OF CARDIAC DEATH
Another card on when to contact Lifecenter Northwest for organ donation
1. Ventilating and devasting injury or illness
2. Loss of one or more brainstem reflexes: pupils fixed, no cough, no gag, no response to painful stimuli, no spontaneous respirations
3. call PRIOR to family discussion of: DNR, comfort care, withdrawal of v
Another definition of death
an individual is considered dead is sustaining either (1) irreversible cessation of circulatory and respiratory function or (2) irreversible cesation of all functions of the entire brain, including the brain stem.
-different criteria is recognized for chi
Common organs for donation after cardiopulmonary death
1. kidneys
2. liver
3. pancreas
What are the three most controversial issues in transplantation?
1. Moral value that should be placed on the human body part.
2. the just distribution of the human body part
3. the complex problems inherent in applying the concept of brain death to clinical situations.
What does Lifecenter Northwest deal with?
Organs
tissues
Sight life donations deal with...
corneas
Northwest tissue services deal with...
tissue donation
The three donor classifications:
1. Heart beating
2. non-heart beating
3. living donor
heart beating classification
1. brain dead
2. mechanically ventilated
3. in ICU or ED
organs that are donated with heart beating typically:
1. solid organs
2. tissue
3. corneas
Non-heart beating classification
1. cardiac death
Non-heart beating donations:
1. some organs
2 tissue
3 corneas
Living donor classification
1. living related
2. living non-related
3. anonymous donation
living donor donations
1. liver
2. kidney
3. blood
4. bone marrow
tissue donations types
1. bone
2. skin
3. heart valves
4. veins
5. connective tissue
*
one tissue donation can help 150 ppl
*
Bone donations
*
Most used tissue
*
-used in orthopedic surgeries everyday, for pins, cementing, and fractures.
-good for bone cancer
Skin donations
-good for burn pts.
-not disfiguring. can have an open casket
*
typically from the back of a donor
*
*
can donate with brain death or after cardiac death
*
Vein donation
prn basis
heart valve donations
-good for young individuals/children
*
heart valves are size dependent
*
Corneal donation
*
most popular
*
-no blood flow to the cornea, RARELY REJECTED
Recovered in:
-patient room
-morgue
-funeral home
-operating room
-coroner/medical examiner facility
1. not eyes, just cornea
2. a pt can go from blind to 20/20 vision
*
12-24 hrs after death
National donation legislation (three things to know as nurses)
*
Conditions of Participation (CoP)
*
1. Hospitals must contact the donation agencies
in a timely manner about all deaths, including
imminent deaths (Glascow coma scale of 5 or less), before assistance is withdrawn, or predicated death.
2. The donation ag
How is a donor designated?
� Driver's license and/or Donor Registry
-yesidaho.org
-donatelifetoday.com
� Donor process explained to the family
� Family and hospital support provided
Pt referral process for hospitals
**C.O.P. states: Hospitals must notify the Donation
Agencies of all deaths, including imminent deaths**
� No matter the age
� No matter the cause of death
*
IMMINENT DEATH
*
� Patient has suffered a neurological injury
� Patient is on a ventilator (heart
Family approach with organ donation
*
If donation is an option, the family needs to be approached by a donor agency coordinator or by a trained hospital requestor
*
1.Organ Donation: Donation Coordinator will come
on-site to the hospital to discuss donation options with
family.
2.Tissue/Cor
Religious view on donation
*
no major religion against donation
*
-don't make assumptions
-get correct info to the family and then let them make the choice.
Hyperacute rejection
*
Occurs within mins to hrs of implantation of the organ
*
1. Caused by the presence of antibodies such as destructive humoral or B-cell reaction to antigens on the vascular endothelium results in organ necrosis.
*
organ must be removed right away, common
Prevention of hyperacute rejection:
1. Previous panel-reactive antibody (PRA) assay
2. hystocompatibility testing
3. crossmatching
Treatment of hyperacute rejection
1. received kidney or kidney and pancreas may have to return to dialysis
2. other organs-plasmapheresis (removes circulating antibodies from the blood).
*
if these measures fail, retransplantation is indicated
*
Acute rejection
*
occurs within the first 3 months
*
1. can occur at any time, particularly if the immunosuppression regimen is altered or if an infection develops.
2. can be a purely cellular immune response mediated by T-cells or antibody-mediated response, or a combin
How do you treat acute rejection?
1.High dose steroids
2. IF recurrent episodes occur, Muromonab CD3 (Orthoclone OKT3)
Chronic rejection
*
evolves gradually, usually after the first 3 months after transplantation
*
1. May be the result of...
-frequent episodes of acute rejection
-increased ischemic time
-CMV infection (cytomegalovirus)
Chronic rejection results in...
1. progressive loss of graft function
2 the transplanted organ develops a persistent, perivascular inflammation assoc. w/ focal myocyte necrosis.
Treatment for chronic rejection
1. treated the same as acute rejection
2. Retransplantation may be required as a result of the progressive deterioration of organ function.
Symptoms of organ rejection
�The organ's function may start to decrease
�General discomfort, uneasiness, or ill feeling
�Pain or swelling in the area of the organ (rare)
�Fever (rare)
�Flu-like symptoms, including chills, body aches, nausea, cough, and shortness of breath
The sympto
Possible complications of organ transplants
�Certain cancers (in some people who take strong immune suppressing drugs for a long time)
�Infections (because the person's immune system is suppressed)
�Loss of function in the transplanted organ/tissue
�Side effects of medications, which may be severe
Prevention of organ rejection
1. HLA typing (tissue antigen)
2. Blood typing ABO
Considerations in psychosocial evaluation for transplantation
Age, marital status, support systems, insurance, savings, smoking, drinking, illicit drugs, coping skills, O2 requirements, dialysis, compliance w. meds regimen, compliance w. clinical appts, ability to get to to clinic or hospital, travel time to transpl
Nurses role in organ donation
Plays a role in organ donation and recovery by....
-early identification of potential donors
-making referrals to OPO
-assisting in the medical management of organ donors.
-act as a liason for donor families
-involved in the clinical management of the don
viability times for donated kidneys
48-72 hrs
viability time for the heart
4-5 hrs
viability time for the lung
4-6 hrs
viability time for liver
24-30 hrs
viability time for the pancreas
24hrs
Read on pgs 2145-2146 about basic immunology related to transplantation
...
Before transplantation, the potential recipient undergoes...
1. ABO typing
2. Rh typing
3. HLA tissue typing
4. PRA (assay for performed reactive antibodies)-determines the presence of performed antibodies to HLA antigens.
pancreatic transplant nursing care
1. monitoring for fluid and electrolyte imbalances
2. BUN
3. Creatinine
4. bicarbonate
5. CO2 levels
6. Urine amylase is also monitored to assess pancreatic function
clinical manifestations of graft thrombosis of the pancreas
1. sudden increase in blood glucose concentration.
2. severe graft pain
3. increased serum creatine level
Nursing care of the heart transplant
1. auscultation of the heart and breath sounds and assessment of pedal puses and of the jugular vein for distention
2. Ongoing assessment of renal and liver function
3. monitoring of immunosuppressant drug levels and the CBC
complications seen after the heart transplant
1. organ dysfunction
2. rejection
3. infection
4. coronary vasculopathy
5. malignancy
Signs and symptoms of rejection of heart transplant
1. fever
2. SOB
3. fatigue
4. presence of S3 or S4 heart sounds
5. decreased ejection fraction
6. JVD
Nursing care of a liver transplant
postoperative care includes...
1. monitoring the graft function
2. managing fluid and electrolyte imbalances
3. preventing problems with other organ systems
4. assessing for manifestations of rejection
*
critical evaluation of the donor for metastatic dis
signs and symptoms of liver transplant rejection
1. fever
2. elevated liver enzymes
3. change in color, amount, and consistency of bile drainage through T tube.
nursing care of the lung transplant patient
1. administration of immunosuppressant drugs and monitoring levels
2. electrolyte determinations
3. liver function tests
4. CBC
5. chest radiography
6. pulmonary function tests
complications of lung transplants
1. surgical side effects
2. graft dysfunction
3. rejection
4. infection
5. bronchiolitis obliterans
immunosuppressant agents used to prevent rejection of organs
1. Calcineurin inhibitor-Prograf,
2. cyclosporin-Neoral
3. corticosteroid-prednisone
4. mycophenolate mofetil-CellCept
5. azathrioprine-Imuran
Complication related to immunosuppressive therapies
1. nephrotoxicity
2. HTN
3. hyperlipidemia
4. bone loss
5. new onset diabetes mellitus
6. increased risks for infections