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Organ Transplant (Organ procurement (Organ Allocation: Medical Urgency…

- - - - PRA: higher PRA = higher organ rejection risk, so Pt w/ higher PRA that gets a match has higher priority in getting organ b/c rarer to get match
      - blood crossmatching done b4 surgery to assess risk for rejection, incompatible crossmatch means the donor and recipient blood cells CANNOT exist together
        
        done 2 times b4 surgery
- - - - from immunosuppression of stress response and immunosuppressive therapy
    - - from environmental/physiological stress reaction
  - - - from life-long prednisone regimen
    - - from lifelong immunosuppression
- - - - PRE
        
        optimize med management of end-stage organ disease to optimize health status while awaiting transplant
        
        ongoing Pt education and emotional support
      - POST
        
        implications of having newly transplanted organ and polypharmacy (having multiple drugs to treat single ailment)
    - - ensuring adherence to med regimen
      - substance use Hx and current status
      - mental status, coping mechanisms
      - family/social support
      - financial implications and insurance benefits
- - - - does Pt seek addtnl health info? Does Pt try to improve health status? Does Pt understand treatment options and implications?
      - is Pt active but compliant in their care or controlling or passive in receiving recommendations in their care?
- - - - neuro assessment NOT consistent w/ brain death
      - care team/family decision to withdraw support
      - OPO approach family about donation unless Pt's family approaches topics
      - death pronounced on cardiopulmonary criteria
      - family decision to w/draw care
      - Pt brought to OR for removal of tissues and organs
    - - death pronounced on neuro criteria
      - OPO approach family about donation unless Pt's family initiates discussion
      - Pt is maintained on hemodynamic support and brought to the OR w/ intact circulation for surgical recovery of organs/tissues
- - - - keeping donor in homeostasis to preserve organ functions/ preventing organ damage from:
        
        hypotension
        
        impaired gas exchange
        
        excessive urinary output
        
        electrolyte imbalances
        
        hypothermia
  - - - clinical eval/testing
      - multidisciplinary team
      - Pt selection/listing
    - - donor/recipient matching and organ allocation
      - donor management
    - - rejection/infection
      - immunosuppression