Tissue and Organ Donation

Article Author:
Erind Muco
Article Editor:
Hani Douedi
Updated:
4/28/2020 12:58:27 AM
PubMed Link:
Tissue and Organ Donation

Definition/Introduction

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.[1] Following such determination, select organ(s) may be procured from the donor and then transplanted into a host.

Issues of Concern

The main concerns surrounding tissue/organ donation are systematic, donor/organ, or permission issues.[1][2] 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.[3][4]

Clinical Significance

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.[5]

Following donor optimization, standard organ removal in the operating room is as follows: heart and lungs first, followed by hepatectomy, pancreatectomy, and bilateral nephrectomies.[6] 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.[7]

Following successful transplantation into a host, the mainstay of long-term care is a combination of lifelong close monitoring and appropriate immunosuppression.[8][9][10] 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.[11][12] Furthermore, non-invasive markers found in blood and urine are now beginning to replace biopsies in assessing for immunologic injury.[13][14]

Nursing, Allied Health, and Interprofessional Team Interventions

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.

Nursing, Allied Health, and Interprofessional Team Monitoring

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.[15] 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. 


References

[1] Thuong M,Ruiz A,Evrard P,Kuiper M,Boffa C,Akhtar MZ,Neuberger J,Ploeg R, New classification of donation after circulatory death donors definitions and terminology. Transplant international : official journal of the European Society for Organ Transplantation. 2016 Jul;     [PubMed PMID: 26991858]
[2] Israni AK,Zaun D,Bolch C,Rosendale JD,Snyder JJ,Kasiske BL, Deceased Organ Donation. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2016 Jan;     [PubMed PMID: 26755269]
[3] Jericho BG, Organ Donation After Circulatory Death: Ethical Issues and International Practices. Anesthesia and analgesia. 2019 Feb;     [PubMed PMID: 29787408]
[4] Freeman RB,Bernat JL, Ethical issues in organ transplantation. Progress in cardiovascular diseases. 2012 Nov-Dec;     [PubMed PMID: 23217432]
[5] Todd PM,Jerome RN,Jarquin-Valdivia AA, Organ preservation in a brain dead patient: information support for neurocritical care protocol development. Journal of the Medical Library Association : JMLA. 2007 Jul;     [PubMed PMID: 17641753]
[6] Young PJ,Matta BF, Anaesthesia for organ donation in the brainstem dead--why bother? Anaesthesia. 2000 Feb;     [PubMed PMID: 10651668]
[7] Hicks M,Hing A,Gao L,Ryan J,Macdonald PS, Organ preservation. Methods in molecular biology (Clifton, N.J.). 2006;     [PubMed PMID: 16790859]
[8] Kuypers DR,Le Meur Y,Cantarovich M,Tredger MJ,Tett SE,Cattaneo D,Tönshoff B,Holt DW,Chapman J,Gelder Tv, Consensus report on therapeutic drug monitoring of mycophenolic acid in solid organ transplantation. Clinical journal of the American Society of Nephrology : CJASN. 2010 Feb;     [PubMed PMID: 20056756]
[9] Shihab F,Christians U,Smith L,Wellen JR,Kaplan B, Focus on mTOR inhibitors and tacrolimus in renal transplantation: pharmacokinetics, exposure-response relationships, and clinical outcomes. Transplant immunology. 2014 Jun;     [PubMed PMID: 24861504]
[10] Gaston RS, IMPROVING LONG-TERM OUTCOMES IN KIDNEY TRANSPLANTATION: TOWARDS A NEW PARADIGM OF POST-TRANSPLANT CARE IN THE UNITED STATES. Transactions of the American Clinical and Climatological Association. 2016;     [PubMed PMID: 28066070]
[11] Lefaucheur C,Loupy A,Zeevi A, Complement-binding anti-HLA antibodies and kidney transplantation. The New England journal of medicine. 2014 Jan 2;     [PubMed PMID: 24382075]
[12] Lefaucheur C,Viglietti D,Bentlejewski C,Duong van Huyen JP,Vernerey D,Aubert O,Verine J,Jouven X,Legendre C,Glotz D,Loupy A,Zeevi A, IgG Donor-Specific Anti-Human HLA Antibody Subclasses and Kidney Allograft Antibody-Mediated Injury. Journal of the American Society of Nephrology : JASN. 2016 Jan;     [PubMed PMID: 26293822]
[13] Kurian SM,Williams AN,Gelbart T,Campbell D,Mondala TS,Head SR,Horvath S,Gaber L,Thompson R,Whisenant T,Lin W,Langfelder P,Robison EH,Schaffer RL,Fisher JS,Friedewald J,Flechner SM,Chan LK,Wiseman AC,Shidban H,Mendez R,Heilman R,Abecassis MM,Marsh CL,Salomon DR, Molecular classifiers for acute kidney transplant rejection in peripheral blood by whole genome gene expression profiling. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2014 May;     [PubMed PMID: 24725967]
[14] Roedder S,Sigdel T,Salomonis N,Hsieh S,Dai H,Bestard O,Metes D,Zeevi A,Gritsch A,Cheeseman J,Macedo C,Peddy R,Medeiros M,Vincenti F,Asher N,Salvatierra O,Shapiro R,Kirk A,Reed EF,Sarwal MM, The kSORT assay to detect renal transplant patients at high risk for acute rejection: results of the multicenter AART study. PLoS medicine. 2014 Nov;     [PubMed PMID: 25386950]
[15] Ghiyasvandian S,Zakerimoghadam M,Peyravi H, Nurse as a facilitator to professional communication: a qualitative study. Global journal of health science. 2014 Nov 16;     [PubMed PMID: 25716406]