Transplantation: understand assessment, matching and continuing care
Transplantation replaces an organ or tissue with a donated one in suitable circumstances. This guide focuses on the broad ideas behind solid-organ transplantation, using kidney care as an example. The details differ by organ, person and health system, so one pathway should not be assumed to describe every transplant.
The possible benefit must be considered with the individual risks
An evaluation will consider whether a transplant might be an option and whether the patient could endure the required treatments. These discussions would cover the advantages, disadvantages and other options. The tests used to gather this data would address specific queries; they could also identify issues needing additional assessment. Referral for evaluation is different than determining a patient has been cleared for a transplant.
Example: Consider a hypothetical case where a patient is having kidney care discussed as a possibility for a transplant. Define the difference between evaluating a transplant (a preliminary step) versus waiting for a suitable donor and then offered a transplant. Provide explanations for each step. A general description of each would not accurately state the length of time that someone waits to receive an organ or their eligibility. Questions regarding the amount of time spent waiting for an organ or their eligibility would be directed to the transplant team involved and current policies within the respective healthcare system.
Donor suitability involves more than the name of the organ
Matching (compatibility) considerations of a potential kidney transplant involve more than just the type of organ being considered. Compatibility assessment of a kidney transplant may include the individual's blood type, tissue characteristics and relevant antibodies. In addition to the blood type and antibody profile of the individual receiving the transplant, there is also an assessment conducted of the organ being provided by the donor. Therefore, an offer of a transplant is not merely due to a spot opening up in a queue. Instead, the team assesses relevant information about both parties and new information may potentially impact whether or not the transplant will proceed.
As part of educating others, separate out a consideration relevant to compatibility from those related to preparedness for surgery. While both may apply, they are addressing distinct inquiries. Avoid turning your examples into general rules for allocating organs. Specific matching criteria vary depending upon the type of organ being transplanted as well as the transplant system. Each offer must be discussed relative to its specific merits and drawbacks.
Preventing rejection is part of continuing transplant care
Part of long-term care of individuals undergoing transplants is preventing rejection. Rejection occurs when the immune system identifies a transplanted organ as foreign and attacks it. Immunologic suppression is achieved through medications that minimize such responses. However, immunosuppressive drugs can have untoward effects and thus require continuous monitoring. It is not acceptable to use a general description of a medication class to select or modify an immunosuppressive drug regimen.
In preparation for exams, define what an immunosuppressive agent is designed to do separately from what possible adverse effects it may cause. Both are important in explaining why monitoring is important. Do not stop or change transplant medicines independently, even when you feel well. If you miss doses, experience undesirable effects or find it difficult to adhere to your prescribed medication schedule, report this immediately to your assigned transplant team.
Follow-up continues beyond the operation and discharge
Monitoring and managing post-operative care extends beyond hospitalization and discharge. Post-transplant care encompasses monitoring the function of the transplanted organ, reviewing and monitoring medications and promoting physical and emotional recovery of the individual. The frequency and type of post-transplant care varies based upon numerous factors including, but not limited to, the success of the surgical intervention. Successful completion of surgery does not eliminate the necessity for continued management and support.
Complete a hypothetical care pathway by defining who evaluates the results of post-transplant evaluations and what process patients should utilize if they experience problems between scheduled follow-ups. Differentiate between attending scheduled appointments and directions to seek assistance between appointments. Adhere to guidelines outlined by your transplant team regarding symptoms, medications and contact procedures. This document outlines educational topics and cannot serve as a basis to diagnose whether an individual's symptom is indicative of rejection, an infection or another condition.
Check your understanding
A short quiz, with an explanation after each answer.
Is referral for transplant assessment a guarantee of an operation?
Return to the section you found hardest and explain its example without looking at the page. Check the explanation, then repeat the quiz later. Being able to describe the reasoning is more useful than remembering the position of a correct answer.