Running head: ORGAN DONATION

Organ Donation

Briana Inestroza

Brigham Young University – Idaho

Brother Rodney Sanders

Nursing 422

November 5th, 2018

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Organ Donation

Organ transplantation is a procedure that involves moving functioning organs from one

person to another in need. Donation of organs can save the lives of people with critical illnesses.

Organs can be retrieved from cadavers or from a living donor. There are many different types of

transplantations that are available which include: heart, lungs, liver, kidneys, corneas, bones,

skin, and more (Lewis et al., 2017). The type of organ given depends on what a critical patient

may need and if it is available. The United Network for Organ Sharing (UNOS) has reported

that every 10 minutes, someone is added to the UNOS waiting list and that one organ donor can

save up to eight lives (2018). Organ transplantation comes with risks and benefits that should be

discussed with all parties involved.

Organ Matching Procedure

Organ transplantation is a complex procedure involving testing in the donor and recipient

and careful consideration of other factors. When an organ is being considered for

transplantation, there are several tests required to determine the organ’s eligibility. Examples of

the testing required include: blood type and subtype, transmissible diseases or malignancies,

human immunodeficiency virus (HIV) screening, human leukocyte antigen (HLA) typing, and

anti-antigens (United Network for Organ Sharing, 2018). The results from the test will indicate

whether or not the organ is suitable for transplantation. The distance of the organ to the recipient

is also taken into consideration. An organ’s best chance of survival is correlated to how long it

takes to get to the recipient. When going through the UNOS list, location is considered.

Location is a large factor due to organ preservation. All organs have a different time frame for

the maximum amount of time they can be outside the body. For example: the kidneys can last up

24-36 hours, the pancreas for 12-18 hours, the liver for 8-12 hours, and the heart/lungs for up to
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4-6 hours (United Network for Organ Sharing, 2018). Other factors considered include: age

(pediatric patients are usually placed higher on the list), chance of survival, urgency, and waiting

time.

HLA typing is completed on both donors and potential recipients. While HLA is an

important factor to be considered in donation, the results are of more importance in some organs

that others. For example, kidneys and bone marrow require a closer histocompatibility between

the donor and recipient (Lewis et al., 2017). Closer histocompatibility decreases the risk of

organ rejection.

Antibodies are tested when organ transplantation is being considered. For a patient who

is awaiting an organ, a panel of reactive antibodies (PRA) will be completed. The PRA allows

doctors to see how sensitive a patient is to receiving HLA from another patient. A higher PRA

result indicates that the patient carries cytotoxic antibodies, which can cause an increased risk in

organ rejection. PRA panels are done in order to treat the patient with immunoglobins in hopes

of reducing the number of antibodies (Lewis et al., 2017). When an organ becomes available, a

crossmatch is done with the donor and potential recipients. The crossmatch will determine how

safe it is to transplant the organ by testing the donor’s lymphocytes and recipient’s antibodies. A

negative crossmatch indicates that it is safe to complete the transplant while a positive

crossmatch indicates an absolute contraindication to the transplantation.

Patient Teaching

Patients who wish to be organ donors should be taught about the process and criteria of

how organ donation works. Patient teaching should also involve the patient’s family. If the

patient wishes to be an organ donor after death, the patient should register through the state.

However, registering through the state will not be enough, the patient should share their wishes
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with families so that their wishes may be fulfilled. Even if registered as an organ donor, the

family has a final say on whether or not the organs are donated (Yoost & Crawford, 2016). If the

patient is deceased, the family should be taught about the procedure that will occur in order to

allocate the organs. Families should be taught about the testing and should be prepared about the

need to keep the patient’s heart running in order to ensure the organs are still receiving adequate

perfusion. Families are given the option of how much they wish to donate. Ensure that families

are aware than an open-casket funeral is still possible with organ donation.

Becoming a live donor is another option that is made available. Live donation numbers

are increasing in order to decrease wait time for patients waiting for organs. Live donors must be

in good physical and mental health and over the age of 18. There are three different types of live

donor transplant including: directed donation, non-directed donations, and paired donations

(United Network for Organ Sharing, 2018). The patient should be taught about the different

types of donation options and the screening required to become a live donor. It should be

emphasized that patients should feel no obligation or guilt into becoming a donor. Before

becoming a live donor, the patient should be aware of the possible medical and psychological

risks. The patient should be educated about the available resources to them during recovery.

An organ recipient should be taught about the initial screenings that must occur in order

for a match to become available. Like the donor, the recipient needs to go through some testing

and treatment. When an organ is made available, the patient should be taught about a few

different things including: immunosuppressive therapy and organ rejection.

Transplant recipients must be on immunosuppressants for the rest of their lives.

Immunosuppressive therapy is done in order to reduce the chance of rejection. Although the

therapy is required in order to minimize the chance of rejection, the immune system is still
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necessary to prevent illnesses within the body. The treatment for each patient to receive their

proper balance is different from patient to patient. It is important for the patient to know about

the possible side effects from the immunosuppressants which may include: nausea, vomiting,

diarrhea, neutropenia, nephrotoxicity, anemia, infections, and more (Lewis et al., 2017).

Immunosuppressant therapy is reduced over years if the patient is showing no signs of rejection.

There is always a risk of organ rejection after transplantation. The recipient should be

made aware of rejection risks and the signs to be wary of. Organ rejection may occur as the

body’s natural line of defense initiates after the introduction of foreign tissue. There are three

different types of rejection: hyper-acute, acute, and chronic. Hyper-acute rejection occurs within

the first 24 hours of transplantation, there is no cure besides removing the organ. Acute rejection

occurs within the first 6 months after the transplant and is reversible with early treatment.

Chronic rejection occurs over months to years and is irreversible. The main kind of treatment for

chronic rejection is supportive therapy. The most common signs of rejection include: flu-like

symptoms, fatigue, cough/chest pain, fever, and shortness of breath (Loupy & Lefaucheur,

2018). The patient should be taught that if any of these begin to occur, they should contact their

health care provider immediately.

Nurse’s Role

Nurses play a significant role for the patients and their families, whether it is on the donor

or recipient side. The nurses are there to provide education to the patients and families. Patients

and families rely on the nurse to give them all the information required for them to make an

informed choice. They are there to be with the patient emotionally, physically, mentally, and

spiritually. The nurses are there for the waiting recipients in times of distress and darkness, the

nurses are there if something goes wrong or if something is going right. These patients rely on
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the nurse to be there for them no matter what the circumstance may be. Nurses are with the

patient during the preoperative and postoperative periods and help through the transition phases.

Reflection

Organ donation is a topic that is sometimes talked about pretty lightly. I think it’s easy

for most people to say that organ donation is the right thing to do and that it is what they wish to

do without taking family into consideration. The topic of organ donation may be difficult for a

family who is mourning their loved one and is not always an easy call to make. It’s important to

talk about organ donation with your family and to share your wishes if you wish to become an

organ donor. A serious conversation about organ donation can allow for easier decision-making

when the time comes. I believe that if it is one’s wish to donate their organs than those wishes

should be granted. Organ donation is a selfless act that can save the lives of many people.

Whether one is donating to another living person or to science, good is coming out of their act.
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References

Lewis, S., Butcher, L., Heitkemper, M., Harding., M., Kwong, J., & Roberts, D. (2017).

Medical-surgical nursing: Assessment and management of clinical problems (10th ed.).

St. Louis, MO: Elsevier.

Loupy, A., & Lefaucheur, C. (2018). Antibody-mediated rejection of solid-organ allografts. The

New England Journal of Medicine, 379(12).

United Network of Organ Sharing (2018). Organ procurement and transplantation network

policies. Retrieved from

https://optn.transplant.hrsa.gov/media/1200/optn_policies.pdf#nameddest=Policy_04

Yoost, B., & Crawford, L. (2016). Fundamentals of nursing: Active learning for collaborative

practice. St. Louis, MO: Elsevier.