Download ORGAN AND TISSUE TRANSPLANTATION

ORGAN AND TISSUE
DONATION
AND
RECOVERY
DANA BARTLETT, BSN, MSN, MA, CSPI
Dana Bartlett is a professional nurse and author.
His clinical experience includes 16 years of ICU and
ER experience and over 20 years of as a poison
control center information specialist. Dana has
published numerous CE and journal articles,
written NCLEX material, written textbook chapters, and done editing and reviewing
for publishers such as Elsevire, Lippincott, and Thieme. He has written widely about
toxicology and was recently named a contributing editor, toxicology section, for
Critical Care Nurse journal. He is currently employed at the Connecticut Poison
Control Center and is actively involved in lecturing and mentoring nurses, emergency
medical residents, and pharmacy students.
ABSTRACT
Organ transplantation rates have increased in the past several decades
and yet nursing education with respect to the process of organ
donation and post transplant care has been inconsistent. Certain state
jurisdictions, such as New Jersey, are now requiring nurses to receive
continuing education on organ donation and transplantation to renew
their license to practice. The goal of mandatory education is to
increase nursing knowledge and participation in organ donation and
transplantation programs, and to advance the role of nurses in this
continuously growing area of health care.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
1
Policy Statement
This activity has been planned and implemented in accordance with
the policies of NurseCe4Less.com and the continuing nursing education
requirements of the American Nurses Credentialing Center's
Commission on Accreditation for registered nurses. It is the policy of
NurseCe4Less.com to ensure objectivity, transparency, and best
practice in clinical education for all continuing nursing education (CNE)
activities.
Continuing Education Credit Designation
This educational activity is credited for 1 hour. Nurses may only claim
credit commensurate with the credit awarded for completion of this
course activity.
Statement of Learning Need
Recent studies have shown that nurses' attitudes and advocacy to
discuss transplantation among colleagues and with others increased
following the appropriate education and practice support. Additionally,
when encouraged to participate in organ donation and transplantation
education, nurses demonstrated increased confidence in working with
transplant patients and in addressing the need to educate their
communities about organ donation, encouraging others to get involved
in local organ donation and transplantation programs.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
2
Course Purpose
This course will provide basic learning for nurses in the coordination of
organ donation and transplantation; and, to increase nursing advocacy
to increase the rates of organ donation in their local areas.
Target Audience
Advanced Practice Registered Nurses and Registered Nurses
(Interdisciplinary Health Team Members, including Vocational Nurses
and Medical Assistants may obtain a Certificate of Completion)
Course Author & Planning Team Conflict of Interest Disclosures
Dana Bartlett, BSN, MSN, MA, CSPI, William S. Cook, PhD,
Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC – all
have no disclosures
Acknowledgement of Commercial Support
There is no commercial support for this course.
Please take time to complete a self-assessment of knowledge,
on page 4, sample questions before reading the article.
Opportunity to complete a self-assessment of knowledge
learned will be provided at the end of the course.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
3
1.
True or false: Registering as an organ donor or reviewing
information about organ donation is mandatory for
obtaining a driver’s license in NJ.
a. True
b. False
2.
Most organ donations are from:
a. Living donors
b. Autologous donors
c. Deceased donors
d. Xenogenic donors
3.
Common complications associated with organ
transplantation include:
a. Transfusion reaction
b. Hyper-metabolic state
c. Diabetes insipidus
d. Infection
4.
Someone who is specifically allowed to discuss organ
donation is a
a. Registered nurse
b. Designated requestor
c. Transplant coordinator
d. UNOS representative
5.
CBIGs are intended, in part, to:
a. Keep the donor patient comfortable until organs can be obtained.
b. Be diagnostic criteria for brain death.
c. Help medical staff determine when to remove life support.
d. Ensure that potential donor organs are hemodynamically stable
and perfused.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
4
Introduction
Organ and tissue donation and transplantation are life saving and life
altering therapies. From 1988 to August 2013 over 580,000 people in
the United States have received organ transplants, and the number of
donors has been slowly but steadily increasing. Tissue transplantation
is also quite common: approximately 750,000 are performed in the
United States every year. The increasing incidence of both donations
and transplants makes it imperative that nurses understand the
processes of how organs and tissues are obtained.
As of 2014, the New Jersey Board of Nursing requires every
professional registered nurse to complete a one-hour course that
covers organ and tissue donation and recovery. As organ donation and
transplantation is more complex than tissue donation and
transplantation (and in many ways the two procedures are carried out
in the same way) this learning module will primarily focus on organ
donation and transplantation.
Epidemiology and Statistics
The first successful organ transplant was performed in 1954. Since
that time, organ and tissue donation and transplantation have become
accepted treatments for a wide variety of diseases and medical
conditions. The three most commonly donated and transplanted
organs in descending order are kidneys, liver, and heart. The organs
that can and are transplanted also include intestines, lungs, and
pancreas and multiple transplants can be done, as well. Tissue
transplantation can be done with amnion, bone, bone marrow,
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
5
connective tissue, cord blood, corneas, heart valves, ligaments,
ovarian tissue, pancreatic islet cells, skin, and veins. Most donated
organs are from the deceased.
Although the number of organ and tissue donations and
transplantations is increasing every year, the demand far exceeds the
supply. There are more than 120,000 people on the transplant waiting
list; in 2016 (to date) there have been almost 28,000 transplants
performed, and each day 22 people die that a transplant could have
saved. In New Jersey in 2015, 531 transplants were performed.
However, almost 2700 people in the state are on the waiting list, and
waiting for an organ is a long process. In the United States the median
waiting time for a kidney is 5.1 years and the situation is similar in
New Jersey. In 2016, some people in New Jersey have been waiting
for a kidney transplant for five years and longer.
Transplants and donations are well established in New Jersey, but
there is a critical lack of registered donors. New Jersey ranks number
44 out of the 50 states in the percentage of registered organ and
tissue donors, and only one-third of New Jersey drivers are registered
as organ donors. Efforts have been made to increase the number of
donors. New Jersey drivers must register through Donate Life NJ
(http://donatelifenj.org/) as someone that is an organ donor or review
information about organ donation when applying for, or renewing a
driver’s license; however, the need for organ donation is still not being
met. As a tissue donation can affect the lives of 50-75 people and one
organ donor can save the lives of eight people, the need to increase
participation is painfully clear.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
6
Basics Of Organ And Tissue Donation And Transplantation
Organ donation and transplantation can be divided into many different
categories.
Donation from deceased donors:
This is the most common type of organ donation.
Donation from living donors:
A donation from a living donor offers several advantages. This
approach increases the possible pool of donors. It allows for a
thorough evaluation of the donor and the recipient and planning or
organization of the surgery. And a living donor also provides an organ
that is usually well perfused.
Allogenic donation:
An allogenic donation is the donation of an organ from another person.
Isogenic donation:
The organ is donated from an identical twin.
Autologous donation:
Tissue is transplanted from one site in the body to another. Autologous
blood donations are relatively common.
Xenogenic donation:
The organ or tissue has been harvested from another species, i.e.,
heart valves from pigs.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
7
Donation after brain death:
Donation after brain death is performed with an organ from someone
who meets the criteria for brain death. These donations usually offer
an organ that is well perfused. Also, these donors can donate multiple
organs, such as, heart, both lungs, both kidneys, liver, pancreas, and
the small intestine.
Donation after cardiac death:
Donation after cardiac death increases the pool of possible donors and
has been, in part, an answer to the shortage of organs available for
transplantation. Transplantation of kidneys, liver, and lungs after
cardiac death is well established and in many cases the outcome for
these procedures is comparable to transplants using organs from
patients that suffered brain death. The most pressing issue in organ
donation after cardiac death is organ ischemia. The implications or
consequences of ischemia for the transplant process are still being
investigated.
Tissue Donation and Transplantation
Tissue donation and transplantation is performed in much the same
way as is solid organ donation and transplantation. However, the types
of tissues that can be used are more numerous, and composite
transplantation - transplantation of several tissue types in one
procedure - can also be performed.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
8
Donation and Transplantation Complications and Risks
The most common complications and risks associated with donation
and transplantation are: 1) Rejection, 2) Infection, 3) Increased risk of
disease, and 4) Adverse effects of immunosuppressive drugs.
Rejection:
Rejection can be soon after transplant or many months later.
Immunosuppressive drugs reduce the rate of rejections, but acute
rejection rate for kidney transplants is still approximately 10-15% and
15-25% for liver transplants.
Infection:
Opportunistic infection after transplantation and infection from the
transplanted organ can be from a wide variety of pathogens, including
(but not limited to) tuberculosis and other bacteria, Clostridium,
cytomegalovirus, HCV, hepatitis E, herpes, Epstein-Barr virus,
parovirus, rabies, group A streptococci, Candida albicans and molds.
The overall risk of infection associated with transplantation is very
small, probably < 1%, but for some procedures, i.e., kidney
transplantation, it is common. However, surveillance for and reporting
of post-transplant infections is not ideal so the actual number of
infections is not known. In addition, there are no universally agreed
upon protocols for screening of organ or tissue donors.
Donors who have infectious diseases such as hepatitis B, hepatitis C,
encephalitis, meningitis, pneumonia, tuberculosis, and other infectious
conditions can be considered as donors if informed consent from the
recipient is obtained and therapy and follow-up are possible.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
9
Increased risk of disease:
People who have had a transplant are at increased risk for developing
bone disease and orthopedic problems, cancer, heart disease, and
other medical problems.
The Process Of Organ And Tissue Transplantation
The process of organ donation is usefully divided into the following
steps: 1) Referral, 2) Evaluation, 3) Family discussion, and
4) Recovery and allocation. The process of organ and tissue
transplantation starts with a referral. Suitable cases are referred to the
local Organ Procurement Organization (OPO); and, there are two in
New Jersey.
New Jersey Sharing Network:
The New Jersey Sharing Network operates in northern and central New
Jersey in Bergen, Essex, Hudson, Hunterdon, Mercer, Middlesex,
Morris, Monmouth, Ocean, Passaic, Somerset, Sussex, Union, and
Warren counties. Their 24-hour telephone number is 1-800-742-7365.
Their website address is http://www.njsharingnetwork.org/contact.
Gift of Life Donor Program:
The Gift of Life Donor Program operates in southern New Jersey in
Atlantic, Burlington, Camden, Cape May, Cumberland, Gloucester, and
Salem counties. Their 24-hour telephone number is 1-800-KIDNEY-1.
The website address is http://www.donors1.org/.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
10
Referral for Organ Donation
The referral for organ donation starts with identification of a patient’s
clinical situation in which organ donation may be likely or could be a
possibility. These situations are recognized by the presence of
imminent death and clinical triggers. Federal regulations require that
hospitals contact the local OPO about all patients that have died or are
near death - imminent death. When the OPO has been contacted, it
will start the process of evaluation and, possibly matching of donor to
recipient. It was in the federal regulations that hospitals develop a
definition of imminent death, and this definition is usually:
1. A patient with acute, severe, brain injury who requires
mechanical ventilation
2. A patient who is being evaluated for brain death
3. The presence of certain clinical findings
The clinical findings that are used most often are: 1) A Glasgow Coma
Scale of ≤ 5; and, 2) The absence of two or more cranial reflexes, i.e.,
caloric response, cough/gag reflex, corneal reflex, failure to respond to
pain, pupillary response to light, etc. The Glasgow Coma Scale and the
cranial reflexes are used because they have a high degree of interobserver reliability and they correlate well with outcome, i.e., the
lower the Glasgow Coma Scale and the fewer intact cranial reflexes the
worse the outcome is likely to be. Taken as a whole, the conditions 1
and 2 listed above and the clinical findings are referred to as clinical
triggers. The clinical triggers are identified in cases in which the
patient is critically ill and near death, and identify patients that may be
donor candidates because they are likely to die or progress to brain
death.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
11
These clinical triggers may vary from hospital to hospital and between
different OPOs. It is also considered necessary to contact the OPO
prior to discussing organ donation with the patient’s family. In the
case of a death and possible organ or tissue donation, the referral
must be made within an hour of the death. Donations can be made
from a patient who has been declared brain dead or from a patient
who has suffered cardiac death. If a patient has suffered a nonsurvivable injury but does not meet the criteria for brain death, the
decision may be made to remove the patient from life support, and
this would be considered donation after cardiac death. If this happens,
organ donation is a possibility.
Evaluation
A donation specialist from an OPO does the evaluation of a patient and
the clinical situation for the possibility of organ donation. Once the
OPO has been contacted about a potential donor, the evaluation
specialist will immediately go to the hospital. The evaluation specialist
will examine the patient’s medical record, tests for infectious diseases
may be ordered, and a decision will be made as to whether or not
organ donation is possible. If the patient was enrolled in the state
registry as a donor, that registration is considered to be the legal
consent for the donation. If the patient was not registered as a donor
and the patient’s driver’s license did not indicate that he/she wished to
be a donor, family or next of kin will be contacted.
Viability of organs is obviously a critical concern in the donation
process. Unfortunately, the majority of donated organs come from
people who are brain dead and these organs are less viable than
organs from living donors. In addition, many people who have suffered
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
12
brain death are physiologically and hemodynamically unstable,
decreasing the potential for maintaining organs in a condition suitable
for transplant.
In response to this issue, OPOs and hospitals have adopted the use of
catastrophic brain injury guidelines (CBIGs) in the evaluation process
of organ donation. Catastrophic brain injury guidelines (CBIGs) are
recommendations used to treat people who: 1) Have suffered a
catastrophic brain injury; and, 2) Have been assessed by a neurologist
and a neurosurgery specialist as having a non-survivable neurological
injury or neurologic death. These guidelines are intended to ensure
hemodynamic stability and tissue perfusion. In this way, the patient’s
clinical progress as it would naturally evolve can be observed and endof-life decisions can be made. As viability of organs is obviously a
critical issue in the donations process, these CBIGs are also used if the
patient is deemed to be a potential organ donor, and they have been
shown to help OPOs and hospitals increase the number and quality of
donated organs.
The CBIGs listed below are from the New Jersey Organ and Tissue
Sharing Network clinical resources section website.
1. Make sure the patient is adequately hydrated and euvolemic.
2. Maintain systolic blood pressure of >100 mm Hg (MAP >60 mm
Hg). If needed, neosynephrine up to 2 mcg/kg/minute is the
vasopressor of choice, followed by dopamine if needed. Consider
using invasive hemodynamic monitoring.
3. Maintain urine output of >0.5 ml/k/hour, < 400 mL/hour. If the
urine output is < 0.5 mL/kg/hour, assess the patient’s fluid
status and rehydrate or consider blood pressure support.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
13
4. Consider the possibility of diabetes insipidus if the urine output is
> 4000 mL/hour x two hours.
5. Treat diabetes insipidus with vasopressin, 1-2.5 mcg/hour. If the
urine output is still >400 mL/hour after vasopressin, give DDAVP
0.5 mcg IV bolus every 2-3 hours.
6. Ensure adequate oxygenation and acid-base balance: Maintain
the PO2 at >100 mm HG, and maintain pH between 7.35-7.45.
PEEP of 5-8 may be needed.
7. Use aggressive respiratory hygiene if not contraindicated by
patient’s condition, i.e., suction and turn every 2 hours,
respiratory therapy treatments to prevent bronchospasm.
8. Maintain temperature between 36-37.5°C
9. Maintain normal values for coagulation/clotting, complete blood
count, electrolytes, and glucose. Normal blood values and
treatment recommendations for specific blood ranges are:
•
Sodium: 134-145 mmol/L
•
Potassium: 3.5 – 5.0 mmol/L
•
Magnesium: 1.8 - 2.4 meq/L
•
Phosphorus: 2.0 - 4.5 mg/dL
•
Ionized Calcium: 1.12 - 1.3 mmol/L
•
Maintain glucose between 80-200 mg/dL and use an
insulin infusion rather than subcutaneous injections for
control of glucose.
•
Monitor and treat Hgb/Hct/Coagulation factors (especially
if GSW or other penetrating head injury)
•
Maintain Hgb >8.0 g/dL and Hct >24%
•
If PT >18.0 give 2u FFP
•
If fibrinogen 70 - 100 give 2u FFP, if < 70 give
cryoprecipitate
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
14
•
If platelets < 50 give 6pk of platelets
The CBIGs will vary from place to place. For example, some OPOs and
hospitals will recommend that the patient be maintained on all
medications he/she was receiving prior to the application of the CBIGs
and that hemodynamic monitoring be used. Tissue matching and blood
typing are an important part of the evaluation process. Blood will be
tested to determine ABO and Rh type, a cross-match between donor
and recipient will be performed, and human leukocyte antigen (HLA)
testing will be done, as well red blood cell antibodies
Family Discussion
The transplant coordinator or evaluation specialist will meet with the
potential donor’s family to discuss the donation procedure. If the
patient had already indicated an intention to donate by registering as a
donor, then in most instances this is considered the only authorization
that is needed and this process may be relatively brief. If the patient
had not expressed a preference, then certainly more time will be
needed. If the procedure is to be a living donation, then obviously, a
family discussion is not needed. It is a requirement that anyone who
approaches a family regarding organ donation must have special
training as a designated requestor.
Recovery and Allocation
The patient is maintained according to an organization’s protocol until
it has been decided to obtain the organs. If life support is removed, as
in donation after cardiac death, the organs must be removed within 90
minutes of extubation. Once the patient has expired, the organs and
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
15
tissues are recovered. The transplant coordinator will be working with
the Organ Procurement and Transplant Network (OPTN) and local
transplant surgeons to find the best match for the donation. The OPTN
is explained as follows:
“… the unified transplant network established by the United
States Congress under the National Organ Transplant Act
(NOTA) of 1984. The act called for the network to be operated
by a private, non-profit organization under federal contract. The
primary goals of the OPTN are to increase the effectiveness and
efficiency of organ sharing and equity in the national system of
organ allocation, and to increase the supply of donated organs
available for transplantation. The United Network for Organ
Sharing (UNOS) ... administers the OPTN under contract with the
Health Resources and Services Administration of the U.S.
Department of Health and Human Services.”
The OPTN, working through UNOS, collects, stores, and analyzes
information that pertains to donors and recipients: donor/recipient
matching, deceased and living donors, and potential recipients, the
patient waiting list, and other information such as name, gender, race,
age, height, weight, medical history, ABO blood group, peak and
current panel reactive antibody (PRA) levels, HLA data, and acceptable
donor characteristics. Race, gender, income, and social status are not
included in the database. When an organ becomes available a
computer program compares information about the donor with
recipient information in the database. The transplant coordinator and
the OPTN will be reviewing all this information about potential
recipients and the donors. Their work and the input of a
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
16
histocompatability laboratory and a transplant team will be
coordinated and, hopefully, an allocation and a match will be made.
Summary
Organ and tissue donation and transplantation are life saving and life
altering therapies, and nurses have a key role in educating their
communities about the existing health need to help save lives.
Despite the rise in need, there remains a critical lack of registered
organ donors that some states, such as New Jersey, are addressing
through mandatory education for nurses and local public programs.
The various organ donation and transplantation steps are supported
through regulatory agencies and healthcare policies, which include
centralized databases and specially trained support staff. Through local
awareness campaigns, such as Save A Life, potential donors may be
informed and take steps to begin the process of helping to save a life,
which begins with the proper referral through to the right
donor/recipient match.
Please take time to help NurseCe4Less.com course planners
evaluate the nursing knowledge needs met by completing the
self-assessment of Knowledge Questions after reading the
article, and providing feedback in the online course evaluation.
Completing the study questions is optional and is NOT a course
requirement.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
17
1.
True or false: Registering as an organ donor or reviewing
information about organ donation is mandatory for
obtaining a driver’s license in NJ.
a. True
b. False
2.
Most organ donations are from:
a. Living donors
b. Autologous donors
c. Deceased donors
d. Xenogenic donors
3.
Common complications associated with organ
transplantation include:
a. Transfusion reaction
b. Hyper-metabolic state
c. Diabetes insipidus
d. Infection
4.
Someone who is specifically allowed to discuss organ
donation is a
a. Registered nurse
b. Designated requestor
c. Transplant coordinator
d. UNOS representative
5.
CBIGs are intended, in part, to:
a. Keep the donor patient comfortable until organs can be obtained.
b. Be diagnostic criteria for brain death.
c. Help medical staff determine when to remove life support.
d. Ensure that potential donor organs are hemodynamically stable
and perfused.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
18
Correct Answers:
1.
True or false: Registering as an organ donor or reviewing
information about organ donation is mandatory for
obtaining a driver’s license in NJ.
a. True
“New Jersey drivers must register through Donate Life NJ
(http://donatelifenj.org/) as someone that is an organ donor or
review information about organ donation when applying for, or
renewing a driver’s license…”
2.
Most organ donations are from:
c. Deceased donors
“Most donated organs are from the deceased.”
3.
Common complications associated with organ
transplantation include:
d. Infection
“The most common complications and risks associated with
donation and transplantation are: 1) Rejection, 2) Infection,
3) Increased risk of disease, and 4) Adverse effects of
immunosuppressive drugs.”
4.
Someone who is specifically allowed to discuss organ
donation is a
b. Designated requestor
“It is a requirement that anyone who approaches a family
regarding organ donation must have special training as a
designated requestor.”
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
19
5.
CBIGs are intended, in part, to:
d. Ensure that potential donor organs are hemodynamically stable
and perfused.
“In response to this issue, OPOs and hospitals have adopted the
use of catastrophic brain injury guidelines (CBIGs) in the
evaluation process of organ donation. Catastrophic brain injury
guidelines (CBIGs) are recommendations used to treat people
who: 1) Have suffered a catastrophic brain injury; and, 2) Have
been assessed by a neurologist and a neurosurgery specialist as
having a non-survivable neurological injury or neurologic death.
These guidelines are intended to ensure hemodynamic stability
and tissue perfusion.”
References Section
The References below include published works and in-text citations of
published works that are intended as helpful material for your further
reading.
1.
2.
3.
4.
5.
6.
Am J Transplant. Special Issue: OPTN/SRTR Annual Data Report
2014. Am J Transplant. 2016;16(S2):4-215.
Bestard O, Cravedi P. Monitoring alloimmune response in kidney
transplantation. J Nephrol. 2016 May 31. [Epub ahead of print].
Cotler SJ. Treatment of acute cellular rejection in liver
transplantation. UpToDate. June 30, 2015.
http://www.uptodate.com/contents/treatment-of-acute-cellularrejection-in-liver-transplantation. Accessed November 22, 2016.
Degnan KO, Blumberg EA.
Human immunodeficiency virus in kidney transplantation. Semin
Nephrol. 2016;36(5):405-416.Eren EA, Latchana N, Beal E, Hayes
D Jr, Whitson B, Black SM. Donations after circulatory death in
liver transplant. Exp Clin Transplant. 2016 Oct;14(5):463-470
Hart, A., Salkowski N, Snyder JJ, Israni AK, Kasiske BL. Beyond
"median waiting time": Development and validation of a
competing risk model to predict outcomes on the kidney
transplant waiting list. Transplantation. 2016;100(7):1564-1570.
Hortlund M, Arroyo Mühr LS, Storm H, Engholm G, Dillner J,
Bzhalava D. Cancer risks after solid organ transplantation and
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
20
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
after long-term dialysis. Int J Cancer. 2016 Nov 21. doi:
10.1002/ijc.30531. [Epub ahead of print]
Iyer A, Chew HC, Gao L, et al. Pathophysiological trends during
withdrawal of life support: Implications for organ donation after
circulatory death. Transplantation. 2016;100(12):2621-2629
Kueht ML, Cotton RT, Galvan NT, O'Mahony CA, Goss JA, Rana A.
Profiling immunologic risk for acute rejection in liver
transplantation: Recipient age is an important risk factor. Transpl
Immunol. 2016 Sep;38:44-9.
Kwon H, Kim YH, Choi JY, et al. Analysis of 4000 kidney
transplantations in a single center: Across immunological barriers.
Medicine (Baltimore). 2016 Aug;95(32):e4249. doi:
10.1097/MD.0000000000004249.
Liu S, Pang Q, Zhang J, Zhai M, Liu S, Liu C. Machine perfusion
versus cold storage of livers: a meta-analysis. Front Med. 2016
Nov 11. [Epub ahead of print]
New Jersey Organ and Tissue Sharing Network.
https://www.njsharingnetwork.org/. Accessed November 21,
2016.
Nin M, Coitiño R, Kurdian M, et al. Acute antibody-mediated
rejection in kidney transplant based on the 2013 Banff Criteria:
Single-center experience in Uruguay. Transplant Proc.
2016;48(2):612-615.
Scalea JR, Sollinger HW. Only time will tell: The future of donation
after circulatory death. Exp Clin Transplant. 2016;14(Suppl 3):2731.
Skov Dalgarrdt, Norgarrd, Povlsen JV, et al. Risk and prognosis of
bacteremia and fungemia among first-time kidney transplant
recipients: a population-based cohort study. Infect Dis (Lond).
2016 Nov 8:1-10.
van Loo ES, Krikke C, Hofker HS, Berger SP, Leuvenink HG, Pol
RA. Outcome of pancreas transplantation from donation after
circulatory death compared to donation after brain death.
Pancreatology. 2016 Nov 7. pii: S1424-3903(16)31229-7. doi:
10.1016/j.pan.2016.11.002. [Epub ahead of print]
US Department of Health and Human Services: Organ Donation
Statistics. http://organdonor.gov/statistics-stories/statistics.html.
Accessed November 21, 2016.
US Department of Health and Human Services. Organ and
Transplantation Procurement Network. State Data.
https://optn.transplant.hrsa.gov/data/view-data-reports/statedata/. Accessed November 21, 2016.
West, S., Soar J., Callaway CW. The viability of transplanting
organs from donors who underwent cardiopulmonary
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
21
resuscitation: A systematic review. Resuscitation. 2016;108:2733.
19. Yuan X, Chen C, Zhou J, et al. Organ donation and transplantation
from donors with systemic infection: A single-center experience.
Transplant Proc. 2016;48(7):2454-245.
20. Nin M, Coitiño R, Kurdian M, et al. Acute antibody-mediated
rejection in kidney transplant based on the 2013 Banff Criteria:
Single-center experience in Uruguay. Transplant Proc.
2016;48(2):612-615.
The information presented in this course is intended solely for the use of healthcare
professionals taking this course, for credit, from NurseCe4Less.com. The information
is designed to assist healthcare professionals, including nurses, in addressing issues
associated with healthcare.
The information provided in this course is general in nature, and is not designed to
address any specific situation. This publication in no way absolves facilities of their
responsibility for the appropriate orientation of healthcare professionals. Hospitals or
other organizations using this publication as a part of their own orientation processes
should review the contents of this publication to ensure accuracy and compliance
before using this publication.
Hospitals and facilities that use this publication agree to defend and indemnify, and
shall hold NurseCe4Less.com, including its parent(s), subsidiaries, affiliates,
officers/directors, and employees from liability resulting from the use of this
publication.
The contents of this publication may not be reproduced without written permission
from NurseCe4Less.com.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
22