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Lesson 4.3: Transplant

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michelle troup

on 6 January 2014

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Transcript of Lesson 4.3: Transplant

Lesson 4.3: Transplant
1. Deciding who receives donated organs is not always a clear-cut issue and involves many difficult decisions guided by federal policy.
2. In organ transplantation, the organ donor and recipient need to have compatible blood and tissue types.
3. Organ transplant surgery is a complex procedure involving various surgical techniques and a variety of biomedical science professionals.
Key Concepts
A kidney transplant usually takes about 3 to 4 hours. The donated kidney is placed through an incision in the pelvis. Typically the patients own kidneys are not removed unless they are causing problems such as high blood pressure or recurrent infections. Both surgeries must be coordinated perfectly so that the transplant surgery begins 30 minutes after the first incision in the nephrectomy occurs. This time constraint is only for live donors.
Activity 4.3.4: You Be the Surgeon
Diana Jones has been receiving dialysis treatment for 6 months. She has been experiencing common complications for dialysis patients. Due to extreme fatigue and joint problems, she has not been able to work for the past 3 months. Diana's brother, Louis, was tested and proven to be a compatible match for a kidney transplant. Due to the complications, they have pushed the surgery to happen as soon as possible.
Activity 4.3.3 Kidney Donation
Diana Jones has End Stage Renal Disease (ESRD). There are only two ways to treat ESRD: dialysis or a kidney transplant. Dialysis is a procedure where an artificial kidney machine removes waste from the blood. Dialysis is not a permanent cure and is extremely time consuming but can preform vital kidney functions. A kidney transplant is the only way to allow a person with ESRD, like Diana, live a normal life. The average wait time for a kidney transplant is longer than three years. The only hope Diana has is for a family member to be a correct match for a transplant. In order to be a match, the donor must have a compatible blood and tissue type.
Activity 4.3.2: Finding a Match
Isabel, a 24-year-old paralegal living with the human immunodeficiency virus (HIV), has been on the waiting list for a transplant for four years. Madison, a 24-year-old real estate agent with type 1 diabetes, has been on the waiting list for a transplant for two years. An organ procurement organization (OPO) has identified a kidney matching both Isabel and Madison. Who do you think should receive the organ in this situation?
Situation #1
New advances can now be done in a less invasive procedure
laparoscopic nephrectomy
. This procedure uses small cylindrical tubes called
in order to enter the abdominal cavity. These trocars allow entry of a fiber-optic video camera to view the inside of the abdominal cavity. Laparoscopic nephrectomies are less painful and do not require the patient to be out of work or in the hospital as long as a traditional nephrectomy. Louis chose to have a laparoscopic nephrectomy.
Laparoscopic Nephrectomy
Single Suture vs. Running Suture
Carlos, a 67-year-old electrician with two grown children and a granddaughter, has been on the waiting list for a transplant for three years. William, a 53-year-old CEO of a Fortune 500 company with no family, has been on the waiting list for a transplant for four years. An OPO has identified a kidney matching both Carlos and William. William is willing to purchase his organ; whereas, Carlos is on Medicare. Who do you think should receive the organ in this situation?
Situation #2
Two separate surgeries are done to provide a live donor with a kidney transplant.
1. Nephrectomy: the donor's kidney is removed
2. Transplant: the kidney is implanted into the patient
Nephrectomies are extremely invasive surgeries that require long incisions and sometimes rib removal.
Kidney Transplants
Activity 4.3.1: Who Should Receive the Organ?
An operating room is like a well-choreographed dance with anesthesiologists, surgeons, and operating room nurses working efficiently together to help the surgery go smoothly.
Activity 4.3.5: Transplant Team
Currently, there are almost 80,000 candidates on the waiting list for a kidney transplant. There are only around 3,000 candidates on the waiting list for a heart transplant. Each year, there are far fewer heart transplants performed than kidney transplants. The number of people waiting for a transplant and the number of transplants performed is only one of the many differences between heart transplants and kidney transplants
4.3.6: Are All Transplants the Same
Organ transplants save about 70 people's life each day. Organ donation is strictly regulated by the government to ensure that organs are distributed in a fair and equitable manner. The federal government passed the National Organ Transplant Act (NOTA) which established the framework for a national system of organ transplants. Under NOTA, the Organ Procurement and Transplantation Network (OPTN) is responsible for formulating allocation policies. It is administered by the United Network for Organ Sharing (UNOS).
The heart is very muscular, giving it the ability to pump blood throughout the human body. It contains four seperate chambers that include two major pumps. These four chambers receive blood and are filled up with it at certain points of the cardiac cycle.
How is the Structure of the Heart related to its function?
1. Compatibility of organ
2. Geographic proximity of donor of recipient
3. Time of recipient on waiting list
4. Age (organs given to children first)
The OPTN Gives Organs Based On:
Deoxygenated blood from the body goes through the right atrium through the superior vena cava. Once its filled, it goes through the tricuspid valve which opens for the blood to flow to the right ventricle. After that, the blood pumps through the pulmonary valve into the pulmonary arteries. It then pumps to the lungs where the oxygen exchange occurs at the alveoli's capillaries. The now oxygenated blood goes back into the heart through the pulmonary veins and into the left atrium. It then goes through the bicuspid valve into the left ventricle.
How does the heart interact with the lungs?
1. How did the OPTN organ allocation policies compare to the class’s choices for each situation?
The heart is enclosed by a sac known as the pericardium and is surrounded by the lungs.
How is the heart attached to the body?
Blood Typing
Since the heart is a major blood pump in the human body, special considerations are definitely required. These special considerations include how the organs in the rest of the body receive blood. During a heart tranplant, the heart cannot pump blood to the rest of the body, endangering the other organs' health. The kidneys are also important organs in the body, but during a tranplant, no other organs are at stake nearly as much.
What special considerations are necessary for a kidney transplant?
The sino-atrial node. The SA node is located on the right atrium and is in charge of initiating electrical impulses through the Bachman's bundle to the left atrium and also through the internodal pathways.
How is the heartbeat regulated?
Route of Administration
: Inhalation
Mechanism of Action
: Sevoflurane produces a loss of perception of sensations by inhalation.
General Uses
: Causes anesthesia before general surgeries

: Agitation, dizziness, drowsiness, lightheaded, and nausea.
Route of Administration
: Inhalation
Mechanism of Action
: Absorbed by diffusion through the lungs
General Uses
: Since its only a weak anesthetic, nitrous oxide is not used as a single agent

: Lack of oxygen, hallucinations, hearing problems, and numbness
Nitrous Oxide (Laughing Gas)
Route of Administration
: Intravenous
Mechanism of Action
: Binds at building site associated with CI ionopore- opening it
General Uses
: Used to help you relax before receiving general anesthesia

: Coughing, sneezing, and hiccups
Route of Administration
: Intravenous
Mechanism of Action
: Barbituates with specific components of GABAA receptors and opens chloride channel
General Uses
: Helps relax the patient before general anesthesia or surgery

: Pain, swelling, seizure, shallow breathing, fast or slow heart rate, nausea, coughing, itching, and muscle pain
Careers Dealing with Transplants:
Administers and manages anesthesia given during surgical procedures
Checks surgical equipment to see if they are working properly
Determines patient medication needed during different types of operations
Works with doctors to inform them of the needed anesthesia
Monitors patients for adverse reactions to medication
Salary Range- $258,330 - $428,890
Average- $345,787
Specializes in transplantation of bodily organs
Directs a surgeon's general sugery skill
Handles the organs that are needed to be transplanted
Works in hospitals, medical centers, or other centers for internal medical programs
Salary Range- $249,500 - $739,531
Average- $519,287
Transplant Surgeons
2.Transplant Surgeons
3.Perioperative Nurses
Assists with patient care in the operating room
Works in a hospital environment; specifically surgical departments, clinics, and physician offices
Works closely to the surgical patient and their family members
Salary Range- $36,029 - $98,033
Average- $67,031
Perioperative Nurses

1. Based on blood type alone, who can donate a kidney to Diana?
3. Why is HLA typing necessary when matching up a kidney donor and recipient?
4. Why is there a 25% chance of a six-antigen match between siblings?
5. Why is a patient with a 25% PRA less likely to reject a kidney transplant than a patient with a 90% PRA?
6. How is a cross-matching test similar to a blood typing test?
8. Based on blood typing and HLA typing results, who is the most suitable match for Diana? Explain your answer.
10. Based on the results of the blood typing, HLA typing, and PRA (if calculated), who is the most appropriate family member to donate his or her kidney to Diana? Explain your answer. What additional test needs to be completed before the transplantation?
11. Calculate the PRA for Diana Jones. Show your work.
12. What does Diana’s PRA indicate?

Tissue Typing
is responsible for stimulating immune response to recognize tissue as self vs. non-self
is controlled by a set of genes located on chromosome 6 called the Major Histocompatibility Complex (MHC)
Two main classes of HLA
Class I: HLA-A, HLA-B, HLA-Cw
When preforming an HLA typing test for a kidney transplant they look at
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