12

1. Organ Donation &
Transplantation
To Save A Life

2. • Introduction
• Definition
• Indications
• Contra-indications
• Organ procurement
• Basic Immunology related to transplantation
• Immunosuppressive therapy
• Transplantation procedure
• Types of Rejection
• Nursing Management
• Patient Education
- OUTLINE:

3. • Organ donation is made for the intention of transferring an organ
or tissue from one person to another
• The main goals of organ donation and transplantation include :
1- changing appearance
2- restoring function
3- improving quality of life
• The first successful organ donation and transplantation was in 1945
• Advances in transplant technology (improved surgical techniques,
immunosuppressive therapy) now permit the donation &
transplantation of various solid organs (heart, liver, kidney,…)
- Introduction:

4. • Organ donation &
transplantation is a surgical
procedure to remove a
healthy, functioning organ
from a living or brain-dead
donor and implant it into
another patient which is
referred to as the recipient.
- Definition:

5. • Organ donation and transplantation is
performed on patients in which their organs are
failing or whom have failed to function normally
and can no longer be used
• Examples:
- Patients with end-stage renal disease
- Patients with congestive heart failure
- Patients with multiple myelomas
- Indications:

6. - Contra-indication:
 Seropositivity for human
immunodeficiency virus (HIV)
 Active Infection
 Severe coronary artery disease with
left ventricular dysfunction
 Malignancy
 Severe peripheral vascular
disease
 Severe carotid artery disease
 Old aged patients (>65 years
old)
 Chronic active hepatitis

7. - Organ procurement:
 Organs and tissues come from 2
primary resources:
1) Cadaver donors (heart beating and
non-heart beating
2) Living related and living non-related
donors

8. - Organ procurement:
1) Cadaver donors: are donors in which death is
irreversible cessation of all functions of the brain
and brainstem. There are 2 types:
- Heart beating cadaver:
 Confirmed brain death but vital organs are
preserved in vivo
 Brain death resulted from: severe neurologic
trauma (head or spinal cord injury), hemorrhage
or anorexia.
 Death must occur in a location in which
cardiovascular support system is available for

9. - Organ procurement:
In order to preserve the vital organs of an
individual who is brain dead, the following
criteria must be fulfilled:
 Systolic BP above 90 mmHg
 Central venous pressure of 5 to 10 mmHg
 Hydration with crystalloids and colloids
 Urine output minimum 100 mL/h
 Mechanical ventilation with 100% oxygen
saturation
 Core body temperature of 37 degrees
celsius

10. - Organ procurement:
1) Cadaver donors: are donors in which death is
irreversible cessation of all functions of the brain
and brainstem. There are 2 types:
- Non-Heart beating cadaver:
• Not suitable for the procurement of parenchymal
organs because major organs have suffered
thrombosed vascular structures and ischemia
• Skin, bones, heart valves, blood vessels,…may be
acceptable for procurement

11. - Organ procurement:
2) Living donors:
- Transplanting from living donors whom are
genetically related to recipients can be more
successful than from cadaver or living unrelated
donors
- Organ donation and transplantation from
unrelated donors can also be successful when
combined with donor specific immunosuppressive
drugs

12. - Organ procurement:
2) Living donors:
Advantages of living related donor:
- Donor – Recipients matches are usually good
- Waiting time is reduced
- Procedure is planned and performed under controlled circumstances
Criteria for living donors:
- Voluntary consent given
- Fully comprehend the sacrifice (ex: loss of one kidney, death)
- The donor must be in great health (As shown in pre-procedure
medical and physical history assessment to evaluate their suitability
for donation )
- X-rays and other imaging procedures to conform the presence of the

13. - Basic Immunology related to
transplantation:
 The human body has an innate tendency to reject and destroy
any foreign material (Except for tissues from identical twins)
Pre-operative matching of Donor to Recipient:
- Cross matching is used to determine specific antigen called
Major Histocompatibility Complex (MHC).
- It is the human leukocyte antigen (HLA) located on chromosome
6
- Antigens of the HLA complex are 2 classes (I & II)
Before transplantation, recipient undergoes ABO typing, Rh typing
and HLA tissue typing:
- Positive cross-matching result = antibodies are present = rejection of
organ

14. - Immunosuppressive therapy:
 The main factor for a success of organ donation and
transplantation is:
Suppressing the immune response to prevent organ
rejection
- Medication is individualized for each patient and dose should
be kept within the therapeutic range to void these range to
avoid these complications:
 Increased risk of infection
 Joint necrosis

15. - Immunosuppressive therapy:
 Immunosuppressive drugs can be
classified into 5 groups:
 Glucocorticoids
 Cytostatic
 Antibodies
 Drugs acting on immunophilins
 Other drugs

16. - Transplantation procedure:
1) Two teams are used for the transplantation
procedure (One team procures and preserves
the donor organ, the other team prepares the
recipient site and transplants the organ to the
recipient)
2) The donor is administered general anesthesia
and an incision is made to remove the donor
organ
3) The blood vessels of the donor organ are cut
and clamped. Then, the vessels are tied off
and the incision is sutured closed per routine
technique of surgery

17. - Transplantation procedure:
Preservation of organ:
- The successful use of donor tissue depends on
the rapid organ resection and cooling because
ischemia must be kept to a minimum
- As soon as the organ is excised from the donor,
it is placed in sterile container and flushed with
cold heparinized solution to remove red blood
cells, then using hypothermic drips of solution
(normal saline 0.9%) until the transplant takes
place

18. - Transplantation procedure:
Recipient transplant operation:
1) General anesthesia and antibodies
given to prevent possible infection
2) A catheter is placed in the bladder
before surgery begins
3) An incision is made and the surgeon
implants the organ in the suitable site

19. - Transplantation procedure:
Normal results:
- The organ may take several weeks
before functioning, during the period in
which, the patient must be kept under
observation
Note: Living donor organs are more
likely to begin functioning earlier than
cadaver organs
Abnormal results:
- Rejection of the organ occurs

20. Types of Rejection:
Type Characteristics Outcome
 Hyper acute - Occurs within hours
after transplantation
- Results in immediate
graft failure
- Includes thrombosis
and extensive
destruction of
allograft vasculature
- Irreversible and
untreatable
- Transplanted
organ must be
removed

21. Types of Rejection:
Type Characteristics Outcome
 Accelerated - The graft may
function for up to 5
days
- Then rapid loss of
function occurs
- Immediate
removal of the
transplant

22. Types of Rejection:
Type Characteristics Outcome
 Acute - Occurs within weeks
to 4 months after
transplant
- Systemic and local
symptoms as well as
reduced urine output
and abnormal
laboratory findings
are present
- Treatable and
reversible

23. Types of Rejection:
Type Characteristics Outcome
 Chronic - Develops slowly
over months to years
- Chronic
inflammation results
in scarring tissue and
stenosis of
vasculature of organ
- Untreatable
- Eventually
leads to graft

24. Types of Rejection:
Clinical manifestations of graft rejection include:
 Decreased urine output
 Graft tenderness or pain
 Rising serum creatinine levels
 Rising BUN levels
 Fever
 Weight gain

25. - Nursing management:
- The nurses post-operative role
is to recognize life-
threatening clinical problems,
prevent complications and to
promote the patient’s return
to normal activities with
improved quality of life

26. - Nursing management:
- Assessment of:
 Blood Urea Nitrogen
 Serum Creatinine
 Fluid intake and output
 Temperature
 Weight
 Heart rate
 Respiratory rate
 Blood pressure

27. - Nursing management:
- Possible nursing diagnosis:
 Pain related to transplantation surgery
 Knowledge deficit related to
management of therapeutic regimen
 Altered nutrition:
- Less than body requirements related to
increased caloric intake after
transplantation
- More than body requirements related to
side effects of immunosuppressant agents
 Altered protection and risk for infection
related to immunosuppressive therapy

28. - Nursing management:
- Nursing goals:
 Maintaining hydration
 Avoid fluid overload
 Assessing for manifestation of rejection
 Preventing complications (ex: organ
dysfunction)
 Preventing infection

29. - Nursing management:
- Nursing interventions:
 Observation of vital signs to asses for graft
rejection (increased HR, increased Temp,…)
 Follow universal precautions to prevent
infection
 Maintain aseptic technique
 Remove invasive lines as applicable
 Limit number of visitors
 Asses urine output
 Initiate fluid therapy
 Administer immunosuppressant as indicated
(Steroids, Cyclosporine,…)
 Encourage small frequent meals six times a
day

30. - Patient education:
 Eating at least five servings of fruits and vegetables
each day
 Avoiding grapefruit and grapefruit juice because of
their effect on a group of immunosuppression
medications
 Having enough fiber in your daily diet
 Drinking low-fat or fat-free dairy products, which
is important to maintain optimal calcium and
phosphorus levels
 Walking, bicycling, swimming, low-impact
strength training and other physical activities you
enjoy can all be a part of a healthy, active lifestyle
after transplant