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After Organ Transplantation: What Comes Next?
Submitted by Loxie Kistler, Ed.D., RN, CHUC, of Palm Coast, Florida
Objectives:
1. Identify two care needs associated with the organ transplantation patient.
2. Describe three possible complications associated with the organ transplantation patient.
3. Discuss two diagnostic/therapeutic interventions to help identify the development of
complications in the organ transplantation patient.
Organ transplantation is not a new medical concept used to cure organ disease. The first
successful kidney transplant from a live donor occurred in Boston in 1954 from one twin to
another. Since that date, major improvements have led to transplanting eyes, middle ears, hearts,
lungs, the pancreas, livers, skin and bones. According to the Department of Health and Human
Services, in 2013 over 25,000 organs were transplanted in the United States. The number of
individuals needing an organ transplant far outnumber the amount of available organs. The need
for additional organs has prompted organ procurement groups to lobby Congress to pass
legislation requiring hospitals to approach patients and families regarding organ donation. It is
now a requirement for an organ procurement group to be notified by hospital personnel (possibly
the Health Unit Coordinator) at the time of a patient’s impending death.
Caring for the organ transplantation patient presents challenges for the entire multidisciplinary
healthcare team. Goals for the patient include infection prevention, monitoring for complications
associated with the transplant, prevention of acute and long term rejection and returning the
patient to activities of daily living.
A major concern is the prevention of infections. Transplant patients receive immunosuppressive
medications to help stop rejection of the new organ. This group of patients also remain in the
hospital for long periods after the transplant occurs. A weakened immune system and exposure
to the hospital environment places this patient at risk of developing infections. Common
infections during this post-operative time include (not limited to) urinary tract infections (UTI)
pneumonia, wound and bloodstream infections and viral infections such as herpes simplex.
Transplantation patients are especially vulnerable to viral infections such as hepatitis B and C,
Cytomegalo virus (CMV), Epstein Barr (mononucleosis) and Varicella Zoster (chicken pox and
shingles). The patient may be placed in isolation with limited visitors to protect the patient from
the hospital and outside environment.
Additional infection prevention strategies include the ordering of prophylactic antibiotics,
removal of catheters and IV/PICC lines as soon as possible and educating the family to stay
home if they are feeling ill. The dietician may need notified to wash and/or peel any fruits on the
meal tray to decrease exposure to infectious agents. This patient also requires an annual seasonal
intramuscular flu vaccine (not the nasal mist live virus) and a pneumococcal vaccine every 5
years. Upon discharge, any transplantation patient depending upon a well or cistern for water
supply should be advised to boil water for 1 full minute prior to drinking. Water from public
water suppliers is chlorinated and safe for the transplantation patient.
Another main concern is observing for and preventing rejection of the new organ or tissue.
There are three types of rejection:
1. Hyper acute rejection occurs a few minutes after the transplant and organ must be
removed right away so the recipient does not die. This type of rejection is seen when a
recipient is given the wrong type of blood.
2. Acute rejection may occur any time from the first week after the transplant to 3 months
afterward. Everyone has some amount of acute rejection.
3. Chronic rejection takes place over many years. The body's constant immune response
against the new organ slowly damages the transplanted tissues or organ.
Monitoring for signs and symptoms of rejection rely upon both clinical symptoms and laboratory
results. Careful monitoring of the WBC count could alert the physician to adjust the
immunosuppressive medications. A tissue biopsy may be ordered to observe for signs of
rejection in the new organ or tissue.
Rejection is impacted by the source of the donated organ or tissue. An autograft takes tissue from
the individual and transplants the tissue on the same individual (take skin from the abdomen or
buttocks and transplants to a burn on the arm). And isograft occurs between individuals with
identical genetic makeup such as identical twins. An allograft uses organs or tissue from a donor
of the same species (human to human but not identical genetics) while a xenograft crosses
species (a pig valve placed in a human heart). The autograft and isograft have less risk of
rejection than the allograft and heterograft.
Signs of rejection may include flu-like symptoms, pain at the sight of transplant and general
malaise. A fever is rare as the inflammatory reaction is suppressed due to the
immunosuppressive medications. Organ specific rejection is demonstrated by abnormal finding
associated with the function of that organ (high blood sugars in a pancreas transplant, shortness
of breath after a lung transplant, decreased urine with a kidney transplant, etc).
Immunosuppressive medications also present with risks for the organ transplantation patient.
Along with the increased risk of infection, additional risks include heart disease, cancer,
osteoporosis and diabetes. A key factor in preventing chronic illnesses such as these is a healthy
immune system. In the organ transplantation patient, the immune system is severely depleted and
cannot protect the body against many chronic long term illnesses. Immunosuppressive
medications also may interact with other prescribed medications and the patient may not get the
full benefit of other required medications. Examples of immunosuppressive medications include
Imuran, Prednisone, Prograft and Cellcept. Research is continually occurring in search of new
and improved medications for the transplant patient.
In order to help control for the development of long term chronic illnesses in the organ transplant
patient, physician orders may include regular blood glucose measurement, a low fat low
cholesterol diet, smoking cessation classes and frequent complete blood count (CBC) and
metabolic panels. If signs and symptoms of infection are present, culture and sensitivity (C & S)
tests may be ordered. Additional orders include accurate intake and output (I & O), daily weights
and consults with primary care physicians or transplant specialists. Encouraging exercise as
tolerated is key to aid in preventing heart disease and weight gain.
Routine laboratory tests are necessary to monitor for the following: drug toxicity, graft rejection,
infection secondary to immunosuppression, and the response of liver enzymes after treatment for
graft rejection or after a change in the immunosuppressive regimen. Infection and graft rejection
most often occur within six months following transplantation. In the event that one or both of
these situations occurs, the frequency for laboratory testing will increase in order to closely
monitor the patient's overall response.
Meeting the psychological needs of the organ transplantation patient is a consideration of the
healthcare team. A consideration exists as to the source of the donated organ. Some transplant
recipients may develop a sense of guilt if the donated organ was from a cadaver source. They
may also develop anxiety if the organ was donated by a family member fearing for the future
health of the family member. The development of end-stage organ failure combined with the
realization that life may no longer be possible without medical intervention can lead to
depression, anxiety, noncompliance with diet or medication, and sexual dysfunction in the
transplant patient. The administration of immunosuppressive drugs, such as glucocorticoids and
cyclosporine, has also been implicated in causing psychiatric disturbances such as euphoria,
delirium, generalized anxiety disorder, and interactions with immunosuppressive drugs. Careful
consultation with the transplant team is required prior to prescribing any psychotropic
medication.
The care of the organ transplantation patient requires a multidisciplinary team approach. At the
core of the team is the role of the Health Unit Coordinator as he/she views and is responsible for
placing and monitoring vital orders for the patient’s well-being for quality patient outcomes.
Resources:

Infections in solid organ transplants. www.lahey.org/infectiousdiseases

Long term cancer risks in immunosuppressive regimens after transplantation. www.tornado.com/long-term-cancer-risks-ofimmunisuppressive-regimens

Long term management after transplants. www. Inova.org/health-services/kidneytransplants

Organ transplant-after the transplant. www.nih.gov/medline/article/000815.htm

Prevent infection after the transplant. www.methodisthealth.org
e-Learning QUIZ
ID # Web-12-01-15
DEADLINE FOR SUBMISSION OF THIS QUESTIONNAIRE IS November 30, 2016.
Subject: Organ Transplant
Submitted by: Loxie Kistler, Ed.D., RN, CHUC
Objective: To identify facts about post organ transplant
Resources: Accompanying article submitted by Loxie Kistler, Ed.D., RN, CHUC
Instructions: After reading the article, please write your answers to the following questions on
the answer sheet on the last page.
1. The first successful kidney transplant occurred in ____ and was between _______.
a. 1960 and parent and child
b. 1954 and twins
c. 1948 and cousins
d. 1978 and human and animal
2. Today, the number of available organs _________________ that of the demand for organs.
a. Equal
b. Exceeds
c. Does not meet
d. Doubles
3. The Health Unit Coordinator may be asked routinely to call this agency at the time of
impending death of a patient.
a. An organ procurement organization
b. Home Health
c. The county coroner
d. The local sheriff’s office
4. Immunosuppressive medications are prescribed to help prevent which of the following?
a. Infections
b. Long term chronic illnesses
c. Psychiatric disturbances
d. Rejection
5. The organ transplant patient is more susceptible to which of the following types of infectious
agents?
a. Bacteria
b. Fungi
c. Parasites
d. Virus
6. Your unit has a new admit. The patient is a 56 year old who received a kidney from his
daughter 2 months ago. Which of the following types of rejection might this patient be
experiencing?
a. Acute rejection
b. Chronic rejection
c. Graft rejection
d. Hyper acute rejection
7. All of the following orders are appropriate for the organ transplantation patient EXCEPT:
a. A low cholesterol diet
b. Accurate I & O
c. Daily weights
d. High impact aerobic exercise 4 times a week
8. Your patient was admitted with a diagnosis of possible rejection after a liver transplant. Which
of the following orders would you NOT expect to see on the physician orders?
a. General diet
b. Lab tests for CBC, a metabolic/chemistry profile
c. OR consent for possible liver biopsy
d. Urine for C & S
9. In reading the H & P of a patient, you note they received a pig valve during valve replacement
surgery 6 months ago. This is an example of what type of graft?
a. Allograft
b. Autograft
c. Isograft
d. Xenograft
10. In order to monitor medication levels in the patients prescribed medications, this lab test
might be ordered.
a. CBC with differential
b. Drug toxicity
c. Metabolic panel
d. Type and Screen
Answer Sheet
ID # Web-12-01-15 Organ Transplant
VALUE: 2 NAHUC CONTACT HOURS
Fee: $5 (U.S. Dollars) for NAHUC members, $10 (U.S. Dollars) for non-members
Do not send cash. Make check payable to: NAHUC.
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Directions: Print this answer sheet, circle the most correct answer based on the article and mail the
completed answer sheet, self-addressed self-stamped return envelope along with appropriate fee to:
Linda Winslow
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Only quizzes with at least 70% answered correctly will be awarded contact hours. Please allow up
to 6-8 weeks for quizzes to be returned.
DEADLINE FOR SUBMISSION OF THIS QUIZ IS BY November 30, 2016.
Member #:________Name:_______________________________________________
Phone number: ___________ Email address: _______________________________
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