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Organ Donation

Hannah Thatcher

Brigham Young University-Idaho

Nursing 422

Brother Saunders and Sister Ward

June 5, 2017
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Introduction

Advances in tissue typing tests, surgical transplantation techniques, and therapeutic drug

regimens have improved organ donation success (Bucher et al., 2017). Currently, organs from

many different body systems can be transplanted including the liver, heart, lung, intestine,

kidney and pancreas. Multiple organs may be transplanted at once, or a segment of an organ

may be transplanted.

According to Bucher et al. (2017), there are currently 123,000 people on the national

transplantation waiting list, while fewer than 30,000 receive transplants annually. The demand

for organs is high, and organs are taken from both living and deceased donors. Because of the

shortage of donors, the use of a living related donor is increasing.

Organ Matching: Criteria for Donation and Specific Testing

The criteria for matching with an organ includes compatibility of HLA typing and ABO

blood however, it is not necessary for the donor and recipient to share the same Rh factor

(Bucher et al., 2017). The HLA compatibility required between the donor and recipient is

dependent upon the organ to be transplanted. Certain organs that are less vascular, such as the

cornea, do not require an exact HLA match. Whereas transplanted organs that are highly

vascular, such as the heart, kidney and bone marrow, HLA matching is crucial. This is due to the

accessibility of the transplanted organ to host antibodiesmore vascular areas will result in

transplant rejection if there is a HLA mismatch.

The organ recipient is also tested before the transplantation to determine any preexisting

antibodies against the potential donor. This is a crossmatch, and if the results are negative it is

determined to be safe to proceed with the transplantation. A positive crossmatch is a

contraindication in proceeding with the procedure, as transplant rejection is imminent.

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Receiving an organ is dependent upon the time on the waiting list, geographical location,

medical urgency, and ABO blood and HLA matching (Bucher et al., 2017). Additionally,

because harvesting, transporting, and storing organs takes time many people are left waiting as

their need for an organ increases. These factors have led to an increase in live donors, often times

relatives or friends, giving the anatomical gift to their loved one. This process, too, requires

extensive medical examination.

The psychologist or social worker will first determine the emotional stability of the

patient wanting to donate their organ, and the coping abilities they demonstrate. Additionally, a

health care team determines if the patients will be able to maintain the same quality of life after

donating the organor if doing so will put them at risk for developing health issues themselves.

They must understand the risks and benefits of donation, and consent to proceed with the

donation.

The Nurses Role and Patient Teaching

The nurses role varies throughout the process of interacting with the donor, the recipient,

and their family members, but a compassionate, educative, and advocative approach is a

common theme. Empathetically caring for a patients family is especially applicable in the case

of a brain-dead patient whose body functions are being retained just long enough to collect the

organs. It is important that loved ones are able to say their goodbyes, and that they understand

the donation process. In this scenario, the nurse also acts as an advocate for the patient. The

nurse assists the family in understanding the process in addition to ensuring the health care

provider is aware an organ donation is intended because some organs are time sensitive.

The nurse must work collaboratively with members of the multidisciplinary health care

team to provide quality care for donors and recipients of organs (Mendes, K., Roza, B., Barbosa,
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S., Schirmer, J., Galvao, C., 2017). This may include quality control of care delivery, as well

as coordination of patient care (p. 947, 2017). Organ donation and transplantation can both be

complex procedures involving many members of the health care team and it is the nurses role to

act as a link for the patient.

For the recipient, organ donation is much more than a surgery. Working collaboratively

with the patient and health care team, a lifelong balance between rejection and infection will be

sought. This is due to the many different HLAs that exists, which makes finding a perfect match

nearly impossible (Bucher et al., 2017). Because of this, host rejection is a major problem

commonly encountered. Consequently, immunosuppressive therapy is required long-term for all

transplant recipients. This puts them at risk for an infection, especially within the first couple

months, when their immune system will be suppressed the most to avoid acute rejection. The

patient must be taught the importance of adhering to the immunosuppressant therapy regimen.

Nursing interventions and assessments are dependent on the organ being transplanted.

For example, if a patient receives a kidney transplant, the nurse will closely monitor the renal

function via electrolyte balance and maintenance of fluid. (Bucher et al., 2017). However, some

assessments and interventions are congruent in all transplant procedures. The nurse plays a vital

role in early recognition of organ rejection. Nurses must be aware of the signs and symptoms of

organ rejection and should educate the patient on issues that need to be reported to their health

care provider.

Goals of Organ Donation

The expected and hoped for outcome of organ donation is a higher quality or prolonged

life for the recipient. For example, a patient with end stage renal disease is dependent on dialysis

and must also adhere to strict dietary and lifestyle restrictions (Bucher et al., 2017). There are
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many side effects associated with dialysis, and one year of dialysis can cost as much as a

transplantation. After receiving a kidney transplant, the patient will save money, and many of

the pathophysiologic changes associated with renal disease will be reversed.

Caution is exercised in the recipient selection process in an attempt to minimize potential

complications. ABO blood and HLA matching reduces the risk of organ rejection in the

recipient. In addition, the goal of immunosuppressant therapy is to find the balance of organ

acceptance while circumventing infection.

Reflection

Our bodies are an intricate, and amazing gift to us from our Heavenly Father. We can

show our appreciation for them by treating them respectfullyby being mindful of the foods we

put in, exercising, and living a holistic lifestyle. The principles taught by our Prophets, including

the Word of Wisdom, coincide with many medically recognized disease preventative measures.

However, many face health related trials in which an organ transplant is necessary to

maintain their quality of life. Modern medicine is amazing, and the ability to transplant an organ

and save somebodies life is especially impressive. The Latter-Day Saint Handbook says, the

donation of organs and tissues is a selfless act that often results in great benefit to individuals

with medical conditions (LDS, 2016). I have never known a recipient of an organ transplant, or

donated an organ myself, but each time I renew my drivers license, and am asked if I would like

to be an organ donor, I emphatically say yes. If I am not using it, then somebody else should.
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References

Bucher, L., Harding, M.M., Heitkemper, M.M., Kwong, J., Lewis, S.L., Roberts, D.

(2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems.

St. Louis, Missouri: Elsevier.

The Church of Jesus Christ of Latter-Day Saints (LDS). (2016). Medical and health policies.

Handbook 2: Administering the Church. Retrieved from https://www.lds.org/handbook

/handbook-2-administering-the-church/selected-churchpolicies/21.3?lang=eng&

_r=1#213

Mendes, K., Roza, B., Barbosa, S., Schirmer, J., Galvao, C. (2012). Organ and tissue

transplantation: Responsibilities of nurses.