ORGAN

DONATION &
SCREENING
WEEK 8- SPDX
 ABOUT THE DISEASE

More and more Filipinos become

afflicted with end-stage organ failure,
an incapacitating disease with organ
transplant as the only chance of survival.
Patients on organ waiting lists are
gravely ill and approximately one person
will die each week while waiting for the
transplant. Although organ
transplantation is a universally accepted
mode of medical treatment that
improves the quality of life among these
patients, the scarcity of sources for
transplantable organs plague the nation,
and the rest of the world.
It is important to determine if the donor has an infection that
could be transmitted to recipients through the transplanted
organs and/or tissues. The Organ Procurement and
Transplantation Network policies (for organ procurement
organizations [OPOs]) and FDA and (for tissue and eye banks)
require a medical and social history interview to be conducted
with the deceased donor’s next of kin or another
knowledgeable person.
 DEFINITION OF TERMS
DONOR
an individual authorized to
donate all or part of the
body of a
decedent.1awphilŸalf
VOLUNTARY DONORS
They are not related to the
recipient by blood but have
the willingness and
intention to donate.
LIVING RELATED LIVING NON RELATED
DONORS (LRDs) DONORS (LNRDs)
They are related to the Those who are not related
recipient by blood within by blood to the recipient
the fourth-degree of but bear close emotional
consanguinity. ties with him/her.
ORGAN BANK STORAGE
COMMERCIAL DONORS FACILITY
A facility licensed,
Also known as kidney
accredited or approved
vendors who offer
under the law for the
their kidneys for sale.
storage of human bodies or
parts
 GENERAL POLICY STATEMENTS
• The Department of Health is
committed to abide by the
WHO Guiding Principles on
Organ Transplantation, the
Declaration of Istanbul on
Organ Trafficking and
Transplant Tourism and RA
9208 and its Implementing
Rules and Regulations.
• Directed LNRDs are permitted
• The safety of both donor Foreigners are not
• only when it is voluntary and
and recipient shall be
eligible to receive organs truly altruistic, without any
given highest
from Filipino living non- kind of compensation or
consideration and
related donors. gratuity package attached to it.
transparency regarding
They must be screened and
the risks to both shall be
approved by the Hospital Ethics
pursued rigorously.
Committee. Non-directed LNRD
are not allowed to donate
organs for transplantation.
 GENERAL POLICY STATEMENTS
• The DOH and The Philippine
Health Insurance Corporation
(PHIC) shall enforce this
Administrative Order and
monitor these facilities
through their licensing and
accreditation rules an
regulations to ensure
accessibility, quality and
sustainability of the services
• All professional societies • A Philippine Board for Organ
related to organ donation • In no instance shall any Donation and Transplantation
and transplantation shall kidney/organ be (PBODT) is hereby created for
ensure that all their transported or exported the purpose of overseeing the
members comply with for transplantation abroad implementation of policies
PODTP guidelines relative related to organ
to the practice of organ transplantation.
transplantation.
 TRANSPLANT TRANSMITTED INFECTIONS
VIRAL TRANSMISSIONS
FUNGAL TRANSMISSIONS
• West Nile Virus
• Apophysomyces elegans
• Hepatitis C Virus
• Coccidioides immitis
• Rabies Virus
• Cryptococcus neoformans
• Lymphocytic Choriomeningitis Virus
• Microsporidial species
• HIV
• Eastern Equine Encephalitis Virus

BACTERIAL TRANSMISSION
• Streptococcus pyogenes PARASITE TRANSMISSION
• Mycobacterium tuberculosis • Trypanosoma cruzi
• Multidrug- resistant Escherichia coli • Balamuthia mandrillaris
• Elizabethkingia meningoseptica • Strongyloides stercoralis
• Mycoplasma hominis
• MRSA
• Clostridium spp.
TRANSPLANT COORDINATOR

The transplant coordinator plays a

pivotal role in the care of patients
during all phases of the transplant
process: pre-transplant evaluation,
waitlist management, transplant
admission, and
discharge/posttransplant follow-up.
 PHASE 1: PRE-TRANSPLANT EVALUATION

The transplant coordinator is responsible for the transplant candidate from referral to selection committee
presentation.
● Transplant coordinator is an integral part in assuring appropriate records are obtained and reviewed
prior to the patient’s first visit and throughout the evaluation process, as records become available.
Upon review of the records, utilizing critical thinking skills and protocols, the coordinator determines
if additional information is needed and requests as necessary.
● Once the patient is determined as an appropriate candidate, the coordinator manages the transplant
evaluation, similar to a project management. Upon receipt of the physician’s order for evaluation, the
coordinator works with various departments to schedule appointments and testing. This data is
reviewed and prioritized to determine immediate needs and follow-up versus long-term or ongoing
needs.
● As the evaluation process continues, the coordinator collects data in a systematic manner assuring
inclusion of the patient and family in this process. While scrutinizing the data, the coordinator
identifies patterns in the patient’s history and status providing for a comprehensive assessment of the
patient.
 PHASE 1: PRE-TRANSPLANT EVALUATION

● Patient education is one of the most important functions of the pre-transplant coordinator.
Education of this population is not limited to the patient only but includes the family and others of
the support system. Patient education focuses on disease processes; signs and symptoms of liver
disease, including those that should be reported to the transplant program; symptom management; and
specific information about the transplant process – from evaluation to long-term follow-up.
● The designation of a primary support and additional support persons is the most important part of
patient education the transplant coordinator can discuss. Based upon programmatic considerations, the
transplant coordinator has an in-depth educational session with the support person(s) to assure they
have an adequate understanding of their expectations during all phases of the transplant process.
● There are regulatory requirements mandated by the Centers for Medicare and Medicaid (CMS) and/or
UNOS that must be addressed during the pre-transplant phase. Often, it is simpler and more efficient
to address these during the educational sessions. The first requirement is the consent for evaluation.
The consent for evaluation must be signed by the patient or designee and includes acknowledgement
of receipt of information from the transplant team.
 PHASE 1: PRE-TRANSPLANT EVALUATION

● Multiple listing (wait-listing for transplant at more than one center) is acceptable according to UNOS
policy (United Network for Organ Sharing 2008). However, UNOS allows each center to make the
determination as to whether or not they will allow it. Therefore, documentation that multiple listing
has been discussed with the patient is mandatory. This is the responsibility of the RN coordinator
during the pre-transplant phase. Documentation that education has taken place is required as well and
is completed during the pre-transplant phase.
● After the evaluation is completed, the transplant coordinator gathers and reviews the testing data.
Abnormal results are reported to the provider and a plan is created. The evaluation data is collated
into a standard format and is reviewed at the selection committee. At this committee, all members of
the transplant team speak about their interactions with the patient and family.
● The pre-transplant coordinator lists the patient.
 PHASE 2: PRE-TRANSPLANT

Once the determination of the selection committee is complete, the waitlist management begins.
● This may be done by the same coordinator or some programs have separate waitlist
managers. In either scenario, the main focus of the waitlist coordinator is to manage
those patients who are awaiting transplant
 PHASE 3

During the transplant hospitalization, the RN coordinator is responsible for moving the patient toward
discharge. Important components of this phase are medication and side effects, wound care, and diabetes
teaching for the patient and support person(s) and reportable signs and symptoms emphasizing infection
and rejection, nutrition, and follow-up expectations.
• Medication administration and side effect education is one of the most important functions the
transplant coordinator is responsible for. The education process includes all medications the
patient will take at discharge but focuses on immunosuppressive therapy, antibiotics,
antifungals, antiviral agents, and diabetes medications.
• Wound care education includes how to clean the wound; change any dressings; inspection of the
wound to assess for redness, swelling, drainage, and bleeding; and again reportable signs. The
connection between immunosuppressive therapy and infection is an important component of this
part of the education process since immunocompromised patients are at higher risk for infection
including the surgical wound area.
 PHASE 3

Reportable signs and symptoms are those that are related to the recent transplant but long-term issues as
well. Due to the suppression of the immune system by medications, there is an increased incidence of
infection, particularly in the first 90 days after transplant.
• An elevated temperature should always be taken seriously and evaluated if persistent. Redness,
swelling, or heat from the surgical site, diarrhea, blood in the stool, nausea, and vomiting are
all symptoms that should be evaluated in a timely manner.
• Long term, there is an increased risk of cancer, particularly in former smokers (lung, head, and
neck) and in those patients transplanted for liver cancer (recurrent disease). Skin cancer is also
more prevalent among transplant patients. The importance of sunscreen, protective clothing, and
annual skin examinations by a dermatologist is an area that should be incorporated into
education early on in order to hardwire these lifelong expectations.
 PHASE 3

• Nutrition education by the RN is an extension of the education already provided by the

nutritionist. This includes specific dietary requirements such as diabetic or low-sodium diets,
foods to avoid and those that are encouraged, and appropriate supplements.
• Follow-up expectations include laboratory tests several times per week but with the expectation
that this will decrease over time and keeping clinic appointments which can be several times
per week as well. Posttransplant patients require assistance in taking care of themselves for
several weeks after surgery.
• The support person(s) is an integral part of this process and must be committed to performing
oversight and administration of medications, wound/incision care, transportation to and from
clinic appointments, blood draws, and other procedures as needed. This is typically one person
but can be a combination of family and close friends who will all undergo training of these
tasks.
 PHASE 4

After discharge, the coordinator becomes the center of communication and care for the patient. In some instances,
the coordinator may attend clinic to assess the patient’s progress and report issues to the appropriate provider.
Following these visits, the coordinates any follow-up issues that may have arisen including contacting the patient
about lab results, medication changes, and next appointments
● Coordinator manages the patient similarly to the pre-transplant phase by triaging phone calls,
reporting signs and symptoms, obtaining results of lab tests and procedures, managing imaging
requirements, and communicating with the appropriate provider.
● Thecoordinator requires critical thinking skills and can manage some issues according to protocol.
These patients require frequent lab testing to assess for rejection. Once results are received, the
coordinator either manages the medication changes or, if rejection is suspected, coordinates liver
biopsies and other tests to make that determination. If rejection is diagnosed, the coordinator then
coordinates the treatment and appropriate follow-up. The same is true for issues such as
cytomegalovirus and any infection requiring intravenous infusions.
 LIVING DONATION
These coordinators manage potential and actual donors in order to avoid any hint of coercion. The phases of
transplantation are the same but are for potential donors instead. During phases one and two, the coordinator
focuses on the needs of the donor only and assures that there is no coercion associated with donation.
• In the pre-transplant phase, the living donor coordinator is obtaining and reviewing medical records,
history and physical, to determine if the donor has any issues that would rule him/her out as a potential
donor. Once the donor has been cleared by the first review, the donor coordinator then arranges for
testing.
• Phase 2 is a bit different because it is maintenance of a healthy donor to the point of donation. This can
be an anxiety-provoking time for the donor as he/she continues to contemplate a procedure that is not
without risks. It is imperative that the donor coordinator be available to the donor to reassess mental and
physical health issues and refer to other providers as necessary and again to provide an “out” if needed.
• During phase three, the coordinator is responsible for discharge planning. The education for the donor and
support person(s) includes wound care, pain management, medication administration, reportable signs and
symptoms, and follow-up care.
 THANKS

Does anyone have any questions?

admolde@fatima.edu.ph