Evaluation And Selection Of Donors

OPOs form a vital link between referring donor hospitals and transplant centers and should be notified as early as possible in order to make the determination of suitability for organ donation.

Obtaining consent for organ donation is of paramount importance in increasing organ donation. A caring sensitive approach by trained individuals that have time to spend with families cannot be overstated. Organ procurement personnel, clergy, and nursing staff play a vital role in this area. Once consent is obtained, a review of the patient's history should focus on the mechanism of death, periods of hypotension or cardiac arrest, need for vasoactive medications, and previous surgery. Likewise, the patient's social history, including alcohol and drug use, should be known. Generalized infectious diseases are ruled out by obtaining human immunodeficiency virus (HIV) antigen, anti-HIV-1, anti-HIV-2, human T-cell lymphotoxic virus (HTLV)-1 and HTLV-2, anti-cytomegalovirus (CMV), antihepatitis C virus (HCV), hepatitis B surface antigen (HBSAg) and hepatitis B core antibody. Specific organ function is primarily determined by laboratory data, chest x-ray, electrocardiogram, and echocardiogram.

Since criteria for organ donation are expanding, there are fewer absolute contraindications to organ donation (Table 5.3). Relative contraindications to organ donation have increased since many were previously considered to be absolute contraindications. Table 5.4 should be considered only as a guideline to relative contraindications since many centers have successfully utilized organs from every category listed.

As a general rule, hepatitis C positive donors may be used in hepatitis C positive recipients. Also, as long as hepatic trauma is minimal, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels are decreasing, and macrovesicular steatosis is < 60%, the liver may be used. Hepatitis B core antibody positivity is more controversial, but with long-term hepatitis B immune globulin (HBIG) use, transplantation may be indicated depending on the clinical situa-

Table 5.3. Absolute contraindications to cadaveric organ donation

Malignancy outside central nervous system Prolonged warm ischemia Long-standing hypertension Hepatitis B surface antigen Sepsis

Intravenous drug abuse Human immunodeficiency virus

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