Tissues and organs are procurable from a living or deceased donor. Live donation involves either kidney, partial liver, or lung. This article will discuss postmortem donation, which must first begin with the definition of death. The Institute of Medicine - American National Academy of Sciences clarified that a clinician could declare death using either neurologic criteria or circulatory criteria. Following such determination, select organ(s) may be procured from the donor and then transplanted into a host.
The main concerns surrounding tissue/organ donation are systematic, donor/organ, or permission issues. Systematic issues stem from the failure to identify eligible donors, death not declared within a specific timeframe, or absence of an appropriate recipient. Meanwhile, donor/organ issues stem from medical unsuitability, hemodynamic instability, organ damage, or inadequate perfusion of organs. Lastly, permission issues stem from the denial of organ donation from a potential donor, donor’s family, or other judicial officers.
Care during the organ donation process is multi-faceted and begins with the optimization of the donor following the determination of death using neurologic or circulatory criteria. This process means optimizing cardiopulmonary status via hemodynamic and ventilatory support. Expeditious organ/tissue procurement is the recommendation because, soon after death, inflammatory mediators begin to invade solid organs leading to increased organ immunogenicity.
Following donor optimization, standard organ removal in the operating room is as follows: heart and lungs first, followed by hepatectomy, pancreatectomy, and bilateral nephrectomies. Subsequent organ cooling to 4 degrees C considerably reduces warm ischemia damage to organs; however, it does not completely arrest cellular processes. Therefore, a thorough organ washout technique, along with selecting appropriate preservation solutions, is critical to organ viability leading to decreased immune reaction and formation of oxygen-free radicals upon reperfusion.
Following successful transplantation into a host, the mainstay of long-term care is a combination of lifelong close monitoring and appropriate immunosuppression. Patients must come to realize that there will never come a time in their lives when close monitoring is no longer necessary. Additionally, physicians must understand current standard practices in caring for these patients as well as accept upcoming innovations such as monitoring patients for donor-specific antibodies as a marker of immunologic risk. Furthermore, non-invasive markers found in blood and urine are now beginning to replace biopsies in assessing for immunologic injury.
For a successful tissue/organ transplantation to occur, it requires an extraordinary amount of teamwork from all aspects of the healthcare system. Preoperatively, nurses are required to provide close monitoring of hemodynamic parameters outlined in current standard practices and offer interventions as necessary. Intraoperatively, it is known that various specialties of medicine participate in the operation, requiring extensive and clear communication for surgical success. Finally, allied health professionals play a critical role in maximizing the organ recipient’s return to normal function postoperatively, leading to a happy and healthy life.
Communication is a useful tool that is imperative to positive patient outcomes as it relates to organ transplantation. Research participants recognize that nurses are at the center of communication, seeing as they spend the most time at the bedside amongst all healthcare providers. As such, they become the most powerful means of communicating compliance and good practices to patients during their life-long journey of close monitoring, which involves close screening of infections, organ rejection, and malignancies.
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