Role of nurse in organ donation, retrievel and banking

Seminar presentation

1. Topic – Role of nurse in organ donation, retrieval and banking ( Bsc .nursing 2 year ) RAKCON

2. Introduction Nurses are the one who facilitates coping of patients and families . Since nurse plays a vital role in the last stage of patient , starting from the detection of potential donors to maintaining their self determination ,their role is irreplaceable during the entire procedure.

3. Definition Organ donation – it is the donation of biological tissue / organ of human body ( living or dead ) to a recipient in need . Organs you can donate Include kidney ,heart ,liver , pancreas ,intestine and lungs Organ retrieval - it is the procedure of recovering biological tissue / organ from a living donor ,brainstem dead donor or patients after a declared circulatory death . Organ banking – it is the preservation of donated biological tissue /organ . Technological advancements are trying their hand in Cryo preservation to reduce the wait of recipients.

4. Historical perspective This noble act had its beginning in the 17 century .In 1972 Alexis Crrel developed the techniques for surgical suturing and vascular anastomosis that opened the pathway to solid organ transplantation. Although many attempts at kidney transplantation was made in the early 1900s it was not untill 1954 that Merrel and Murray performed the first successful kidney transplant between two twin identical brothers .In 1970 the relationship between donor and recipient histocompatibility in the role of acute rejection was recognised .With current success and survival statistics these procedures are no longer deemed experimental. Much success is due to the availability of new immunosuppressive therapies, advances in organ preservation ,improved surgical techniques and the recognition of risk factors .

5. Evaluation for donation General Evaluation : Complete medical and physical assessment Psychiatric and social evaluation Laboratory studies Virology and microbiology profile testing

6. Kidney Blood tests Urine analysis Glomerular filtration rate determination Renal ultrasound Kidney ureter bladder radiographic series Heart Hemodynamic evaluation History of smoking History of cardiac arrest Two dimensional echocardiography Cardiac catheterization Liver Ultrasound of liver and biliary tree Pulmonary and cardiac evaluation CT scan of head Series of blood tests Pre cutaneous transhepatic cholangiography

7. General contraindication Presence of active systemic infection. HIV / AIDS Malignant disease ( except skin cancer) Active peptic ulcer disease Active abuse of alcohol and other substances Severe damage to organ organ system ( othr than to be tansplanted) Demonstration of past / current inability to comply Lack of a functional support system Lack of sufficient financial resources to pay for surgery, hospitalization ,medication and follow up care .

8. Organ / tissue preservation Conditions for preservation : Simple hypothermia- 2-8°C Deep preservation-70°C Cryopreservation-0.5-5°C Lyophilization- removal of water of said organ or tissue, this is useful in long storage .

9. Time period for preservation Heart – 4-6 hrs Lungs-4-8hrs Liver- 12-15hrs Kidney – 24-48hrs Pancreas – 12-14hrs Intestine- 6-10hrs

10. The common preoperative procedure While procurement coordinator manages and coordinates the donor process , the clinical transplant coordinator manages and coordinates the preparation of recipient. Blood work Administering preoperative medicines Shaving and preparing skin for surgery Immunological status Medical necessity for transplantation Surgical feasibility of procedure Psychological suitability Assessment of previous medical records .

11. Kidney A kidney transplant is a surgical procedure to place a kidney from a living or deceased donor into a person whose kidneys are longer function properly .It is done during end stage renal disease (ESRD) when changes in diet , regular medications etc cease to work Complications Hypertension Infection Bleeding Blockage of blood vessels to new kidney Leakage of urine or blockage of urine in ureter

12. Heart Reasons why people receive heart tranplants are because they have :Dilated cardiomyopathy, severe coronary artery disease with scarred heart tissue from a heart attack , birth defects of the heart Complications : Blood clots Kidney damage Angia Coronary artery disease Osteoporosis

13. Liver When liver fails due to diseae or injury , biliary atresia, urea cycle disorders etc doctor recommend a liver tranplant . Complications: Bile duct complications Venous thrombosis Bile leak Vascular stricture Malignancy

14. Lungs Lung transplant is advised in case of Copd , pulmonary fibrosis ,emphysema when general medicines don’t improve the general condition . Complications : Kidney damage Diabetes Stomach problems Cancer ( immunosuppressants )

15. The common postoperative procedure Deep breathing exercises Induction therapy Regular recording of blood pressure and fluid status Pain management Self care : post operative education Schedule of return appointment Home are nurse to provide wound care , perform IV infusions and other measures Follow up care Routine dental and ophthalmic examination Communication with referring physician is very important

16. Organ retrieval Multiple organ procurement or retrieval of more than one type of organ from a single donor it’s a standard practice . As many as 4 separate surgical teams may be present in the operating , each focusing on the recovery of a single organ . After a midline incision is made , disscetion of organ occurs . Once cross clamping of aorta is done and cardioplegia is begun , the heart is removed . Then lungs ,liver and finally kidneys are retrieved . The organs are preserved in a cold storage solution selected by the tranplant center. Examples of such soln are University of Wisconsin soln , Euro Collins soln , Belzers soln packed in ice and transported in a cooler to recipient . For successful transplantation , the timing of organ removal and preparation of recipient is essential .

17. Organ banking Organ and tissue banks recover , process , store and distribute human organs , bone and tissue for tranplantation .Donations are made from people who agree to donate upon their death . Organ retrieval banking organisation , a nodal centre for the country has been set up at AIIMS , New Delhi with a purpose of encouraging organ donations fair and equitable distribution and optimum utilisation of human organs . This organisation is maintaining the waiting list of terminally ill patients requiring transplants , donor registration ,matching of recipients with donor , creating awareness etc

18. Related issues Cost – the average costs for surgical procedure + 5 year post transplantation expenses may not be affordable by all .In foreign countries medical expenses are covered by mandatory insurance and various coverage packages . Shortage of organ donors – this is most significant limitation of transplantation.As of Nov 2007 no. Of clients waiting are as follows : 74,066 for a kidney 2880 for a heart 17,141 for a liver 2814 for a lung

19. Contd Ethical consideration – many moral and ethical issues surround tranplantation. Religious and cultural customs related to death and organ donations and tranplantations create challenges for health professionals. As ways to increase the organ donor pool are explored additional ethical dilemmas may be encountered .

20. Role of nurse Nurses are often primary care givers in final stages of a patient They guide and counsel family through this difficult and heart wrenching process Their first obligation should be well being of the patients Nurse plays an important role in organ donation and recovery Early detection of a potential donor

21. Contd Nurse begins to focus on managing the clients until donation is completed.( Infection control, hydration , oxygenation ,etc) Diagnosing brain death Obtaining family consent Managing donor till donation is complete Initation of organ donor process should proceed according to hospital policy .

22. Criteria for becoming a donor He / she must be in good physical and mental health At least 18 years old Be willing to donate Be well informed Have good support system Can be from any community Brainstem dead person is a potential donor

23. Organisational set up for organ donation in delhi National biomaterial centre has been established at National Organ and Tissue Transplant Organisation ( NOTTO) safdarjung hospital , New Delhi an organisation under directorate general of health services , ministry of health and family welfare Govt. Of India and is fully functional . More than 100 NGOs are present in Delhi playing a vital role in organ donation .

24. Research Organ transplantation offers a unique chance to extend and saves lives and improve the health of those in need . The no. Of organ transplants has grown steadily over the past 65 years,with more than 750,000 transplants conducted in United States since 1988. Overall support for organ donation remains high (90.4%)&belief in the benefits of organ donation also remains high (85.1%). However these have both decreased slightly since 2012 . At the same time concerns about organ donation such as that a loved one ‘s body will be disfigured or that doctors are less likely to save a registered organ donors life has risen significantly since 2012.. Respondents were less likely to express willingness to donate while living & less likely to donate their hands and or face .

25. Summary Nursing care of transplant patient is both challenging and rewarding .With thorough understanding of the end stage disease process and its manifestation the organ donation , recovery process and its banking the nurse has the unique ability to work as the member of interdisciplinary team caring for group of clients .

26. Conclusion The nurse serves as a primary care provider , client advocate and a liasion with other team members . So the role of nurse in organ donation , retrieval and banking is unique and irreplaceable during the entire procedure.

27. Bibliography Nursing journal – 501-507 www.notto.co.in www.healthline.co.in