Advanced Donor Management
Why is maintaining normoglycemia crucial in brain-dead donors?
To prevent organ damage caused by hyperglycemia or hypoglycemia; maintains adequate energy supply to organs.
What are the different types of consent related to organ donation (e.g., first-person, family-based)?
First-person (donor's explicit decision), family consent (when the donor's wishes are unknown).
What is the importance of maintaining the cold chain during organ preservation and transport?
Low temperatures slow down cellular metabolism, reducing organ damage.
What is the Glasgow Coma Scale (GCS) score that often triggers a referral for organ donation?
GCS >5
In Donation After Circulatory Death (DCD), when does organ recovery begin?
A. Immediately upon extubation of the patient.
B. After the family has made end-of-life decisions.
C. 5 minutes after cardio-pulmonary arrest.
D. After the organ allocation process is complete.
Correct Answer: C
What are some factors that can mimic brain death and must be ruled out?
High spinal cord injuries, drug intoxication, hypothermia, shock, metabolic impairment, or abnormal lab values
What is the significance of the 2010 National Association of Attorneys General Amendment to the UAGA?
It reinforces the donor's right to decide on donation, preventing others from overriding their wishes without their consent.
What is the typical timeframe for transporting a heart after recovery?
4-6 hours
How does the process of organ procurement differ between DCD and brain death donors?
In DCD, circulatory and respiratory functions cease before organ retrieval, requiring careful timing and management of organ preservation.
Question 1:
A patient is admitted with a Glasgow Coma Scale (GCS) score of 3. The patient is an organ donor; what is the nurse's next step?
A. Begin the process of determining brain death.
B. Immediately contact the Organ Procurement Organization (OPO).
C. Contact the Donor Referral Line within one hour.
D. Administer medications to increase the patient's GCS score
Correct Answer: C
Rationale: A GCS of 3 is a critical finding and indicates the need to initiate a referral to organ donation promptly. According to the presentation, the Donor Referral Line should be called within one hour for ventilated patients with a GCS of 5 or below.
Explain the significance of treating coagulopathy in potential organ donors.
To reduce bleeding complications during organ procurement and improve organ quality.
What are some common neurological complications that can arise in potential organ donors, and what nursing interventions might be needed?
Increased intracranial pressure (ICP), seizures, cerebral edema
Describe the role of immunosuppressive drugs in preventing organ rejection and the potential side effects.
Immunosuppressants suppress the recipient's immune system, reducing rejection risk; but they also cause increased risk of infection, organ damage, and other complications.
What is the role of an Organ Perfusionist in organ donation?
They manage and preserve organs during the recovery process.
A patient is declared brain dead but exhibits Cushing's triad. Which hemodynamic parameter(s) would be MOST consistent with this clinical presentation?
A. Hypotension and bradycardia.
B. Hypertension and bradycardia.
C. Hypotension and tachycardia.
D. Hypertension and tachycardia
Correct Answer: B
Rationale: Cushing's triad involves hypertension, bradycardia, and irregular respirations.
Name three brainstem reflexes that are tested to determine brain death.
Pupillary light reflex, corneal reflex, oculocephalic reflex (doll's eyes), oculovestibular reflex (cold caloric testing), gag reflex, cough reflex
What are the legal requirements for documenting informed consent for brain death testing and organ donation?
Documentation should confirm voluntary and informed consent, including witness signatures and timestamping.
Explain the systemic effects of increased intracranial pressure (ICP) on vital organs in a brain-dead donor.
Increased ICP leads to Cushing's response (hypertension, bradycardia, irregular breathing), and impacts cardiovascular and respiratory function.
What factors does UNOS consider when allocating organs to recipients?
Severity of patient's medical condition, tissue match, waiting time, blood type, body size, immune status, geographic distance, recipient's suitability for transplant
A transplant team is faced with two equally suitable recipients for a single available heart. Both patients are in critical condition, but one is a child and the other an adult. Applying ethical principles of justice and beneficence, which factor is LEAST relevant in the allocation decision?
A. Age of the recipient
B. Waiting list time for each patient
C. Medical urgency of each patient’s condition
D. The likelihood of successful transplantation for each patient
Answer: A
Rationale: While age might influence some personal viewpoints, ethically, age should not be a primary factor in determining organ allocation. Medical urgency, waiting list time, and the likelihood of a successful transplant are more relevant factors in determining the recipient, consistent with principles of justice and beneficence.
What are the legal and ethical considerations surrounding the nurse's role in brain death determination?
The nurse acts as a witness to the process, must be knowledgeable about the legal requirements, and uphold patient rights.
What are the criteria for a potential donor to be considered for DCD donation?
Patient not expected to survive, family consent to withdraw life support, anticipated death within a defined timeframe.
What are some challenges associated with procuring and preserving organs for transplantation?
Short viability window for organs; maintaining cold chain, ischemic times, and appropriate organ handling to prevent damage.
What is the role of the Human Leukocyte Antigen (HLA) system in organ transplantation?
HLA proteins are key in immune recognition; closer HLA matching between donor and recipient reduces the risk of rejection.
A 70-year-old patient with end-stage renal disease and a history of multiple strokes has been declared brain dead. The patient's family is vehemently opposed to organ donation, citing religious beliefs. The patient did not sign an organ donor card. What is the nurse's BEST course of action?
A. Respect the family's wishes and refrain from further discussion of organ donation.
B. Explain to the family the significant benefits of organ donation for other patients.
C. Contact the hospital's ethics committee to consult on the case.
D. Proceed with organ retrieval, as the patient's age and medical history may negate the family's objections.
Correct Answer: C
Rationale: When a patient has not registered their decision about organ donation, and the family objects, an ethics consultation is crucial. The ethics committee helps navigate the conflicting values of respecting family wishes and maximizing potential for organ donation. Options A and B are not appropriate ways to proceed with a complex ethical conflict. Option D is both illegal and unethical.