Section 2: Donation Allocation, and Matching

NUR 433: Adult Health II; MCUSON; Mrs. Cooper

what are the 6 solid organs that can be transplanted

• kidney

• liver

• heart

• lung

• pancreas

• intestine

• sometimes combined (kidney–pancreas for diabetic kidney disease)

if the donor type is _____, a kidney, liver segment, lung lobe, and stem cells can be given

living

some notes for a living donor type include related, emotionally related, altruistic, or paired exchange. living-donor _____ usually work right away.

kidneys

if the donor type is _____, all organs and tissues can be given

deceased

some notes about a deceased donor type is defined after brain death or circulatory death. next of kin may still need to _____

consent

***how priority is set for kidney allocation is through blood type, HLA, PRA, and time waiting

examples of exclusions for kidney allocation: Life expectancy under _____ years; recent cancer; active substance use

2

***how priority is set for liver allocation: MELD score (creatinine, bilirubin, INR)

examples of exclusions for liver allocation: active alcohol or drug use, uncontrolled _____, no social support

sepsis

***how priority is set for heart allocation: UNOS urgency status 1 (ECMO, biventricular pump) to 6

examples of exclusions for heart allocation include over _____, active infection, severe lung disease

70

***how priority is set for lung allocation: Lung Allocation Score

examples of exclusions for lung allocation include MI within _____ days, recent stroke, septic shock, repeated nonadherence

30

The national list is run by _____. Every center does a psychosocial evaluation (support system, adherence history, realistic expectations), because a transplant only works if the patient takes the medicines for life

UNOS

four checks before surgery: _____ _____ _____ must be compatible; Rh matching is not required

ABO blood type

four check before surgery: _____ _____ - HLA-A, -B, and -DR (2 each = 6 antigens); a closer match lowers rejection risk

HLA typing

four checks before surgery: _____ _____ _____ _____ (PRA) - how many HLA antibodies the patient already has. High PRA = highly sensitized = longer wait

panel of reactive antibodies

four checks before surgery: _____ - recipient serum mixed with donor cells. Positive = preformed antibodies; rules out a living-donor transplant unless plasmapheresis or IVIG removes them

crossmatch

HLA matching is critical in _____ and stem cells because of the high rejection risk; 5–6 of 6 matches do best

kidneys

HLA matching in between for hearts and lungs because fewer mismatches help, but short _____ storage times limit searching

organ

HLA matching has little effect on the liver and cornea (none) because the _____ is tolerant of mismatches; cornea has no blood supply

liver

***Practice it: each parent passes one HLA set, giving four possible combinations. A sibling has a 1 in 4 chance of a full match, 1 in 2 of a half match, and 1 in 4 of no match.