Organ/tissue donation, organ transplantations, and GVHD, PPT

ORGAN & TISSUE DONATION

Objectives

  • Discuss Organ & Tissue Donation, Organ Transplantation, and Graft Versus Host Disease (GVHD)

  • Manifestations of each aspect of the topics

  • Treatment & Nursing Management associated with each area

ORGAN & TISSUE DONATION

Overview

  • Patients have the option to donate:

    • Organs

    • Body parts

    • Body tissues

    • Entire body

  • Advance Directives and donor information must be in the medical record before donation takes place.

  • If the patient cannot make a decision regarding donation, the designated next of kin must be consulted at the time of donation.

  • Types of donors:

    • Living Donors

    • Examples include:

      • Kidney
        y - Portion of liver

      • Regenerative tissues (e.g., bone marrow)

    • Deceased Donors

    • Must be declared brain dead before organ procurement.

    • Consent from the next of kin is required.

  • In the Dallas area, the Southwest Transplant Alliance (STA) aids in facilitating organ, body part, and tissue donations.

Donors

  • Live Donors:

    • Undergo extensive medical evaluations prior to donation.

  • Deceased Donors:

    • Must be brain dead; next of kin consent is mandatory.

Lifesaving and Healing Organs and Tissues

  • Commonly donated organs and tissues include:

    • Heart

    • Cornea

    • Lungs

    • Tendons

    • Liver

    • Kidneys

    • Intestine

    • Veins

    • Pancreas

    • Bones

    • Valves

    • Skin

ORGAN TRANSPLANTATION

Overview

  • Transplantation techniques have improved due to:

    • Advancements in surgical techniques

    • Histocompatibility testing

    • More effective immunosuppressant drugs

  • Common tissue transplants:

    • Corneas, skin, bone marrow, heart valves, bone, and connective tissues

  • Common organ transplants include:

    • Heart, lung, liver, kidney, pancreas, and intestine

  • Simultaneous Transplants: More than one whole organ can often be transplanted at the same time; some can be segmented.

Statistics

  • Over 116,000 people are on the organ procurement and transplantation list.

  • Less than 35,000 organ transplants are performed annually.

  • The most frequently requested transplants are for:

    • Kidneys

    • Hearts

    • Livers

  • Matching criteria include:

    • ABO blood type compatibility

    • HLA typing

    • Medical urgency

    • Time on the waiting list

    • Geographic location

  • Patients are generally not eligible for transplantation if:

    • They are medically unstable

    • Have a current or recent cancer diagnosis

    • Suffer from morbid obesity (as per UNSO, 2025)

Tissue Typing & Transplant Rejection

  • Tissue Typing:

    • Recipients typically receive transplants from ABO-compatible blood groups but need not match in Rh factor.

  • Transplant Rejection:

    • A major concern after organ transplantation due to the immune response recognizing foreign tissue.

    • Immunosuppression therapy aims to minimize rejection risks.

    • Achieving a perfect match is extremely rare except with:

    • Self-donation

    • Identical twins

    • Siblings

  • Prevention and early intervention are crucial for long-term graft function.

IMMUNOSUPPRESSIVE THERAPY

Overview

  • Maintaining a balance between preventing rejection and managing infection is essential.

  • Goal of Therapy: Suppress the immune response to prevent organ rejection while still maintaining adequate immune function to fend off infections and cancer.

Major Immunosuppressive Agents

  • Calcineurin Inhibitors:

    • Tacrolimus and Cyclosporine are widely used, with Tacrolimus being the preferred choice.

    • These medications block T-cell activation and interleukin-2 production.

  • Antiproliferative Agents:

    • Mycophenolate mofetil and Azathioprine inhibit T and B cell proliferation.

  • Corticosteroids:

    • Prednisone helps reduce inflammation and suppress immune cell activity.

  • mTOR Inhibitors:

    • Sirolimus blocks T-cell activation pathways.

  • Induction Agents:

    • Basiliximab depletes or inhibits T-cells in the early post-transplant period.

Complications

  • Complications related to transplantation include:

    • Rejection

    • Infection

    • Post-surgical complications

    • Side effects of medications (e.g., leukopenia following kidney transplants)

    • Graft failure

    • Post-transplant lymphoproliferative disorder (PTLD)

Signs/Symptoms of Rejection

  • Potential indications of rejection include:

    • Fever

    • Chills

    • General fatigue

    • Nausea/vomiting

    • Pain over the transplant site

    • Tenderness or swelling

    • Rash

    • Shortness of breath

    • Cough

    • Decreased urine output

    • General malaise

  • Symptoms typically appear within the first few months and cause organ dysfunction (e.g., increased creatinine levels post-kidney transplant).

  • Chronic Rejection: Develops gradually over months to years, leading to:

    • Weight loss

    • Organ failure

    • Graft dysfunction

Nursing Management

  • Pre-transplant:

    • Educate the patient regarding the transplant procedure, lifestyle changes, risks and complications, and psychosocial support.

  • Post-op:

    • Monitor for signs/symptoms of rejection and side effects from medications

    • Reinforce the importance of adherence to immunosuppressive regimens

    • Conduct wound care

    • Provide nutritional support

    • Offer lifestyle counseling and infection prevention tips, especially in relation to sun exposure

    • Provide ongoing psychosocial support

  • Long-term:

    • Facilitate regular clinic visits to monitor graft function and medication levels

    • Encourage self-management skills

    • Monitor and treat complications and/or infections as they arise.

GRAFT-VERSUS-HOST DISEASE (GVHD)

Overview

  • GVHD occurs when the immune cells from the donor graft recognize the recipient's tissues as foreign and mount an immune response against them.

  • Most common in Hematopoietic Stem Cell transplants.

  • The exact reasons for this immune response are not fully understood, but it generally involves donor T-cells attacking the recipient's vulnerable cells.

  • Acute GVHD:

    • Can begin 7 to 30 days after transplantation.

  • Chronic GVHD:

    • Develops over several months.

Signs/Symptoms of GVHD

  • Most common symptoms are:

    • Skin involvement (rash)

    • Fever

    • Liver issues (jaundice, hepatic failure)

    • Gastrointestinal symptoms (diarrhea)

Treatment

  • Main treatment consists of immunosuppressive medications aimed at suppressing the donor T-cells attacking the recipient’s tissues.

  • Corticosteroids: are considered first-line therapy.

  • Other management strategies include:

    • Fluid and electrolyte management

    • Nutritional support

    • Infection management

Nursing Management

  • Close monitoring for any signs/symptoms of GVHD is crucial.

  • Providing supportive care and administering immunosuppressive therapy is essential.

  • Educate the patient about medications, necessary lifestyle modifications, and follow-up care.

  • Early recognition and prompt treatment are vital to prevent potentially life-threatening complications.

REFERENCES

  • Centre for Clinical Haematology (2025). What is graft versus host disease (GVHD)? Retrieved from https://cfch.com.sg/graft-versus-host-disease-gvhd/

  • Harding, M., Kwong, J., Hagler, D., & Reinisch, C. (2023). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems (12th ed.). Elsevier: St. Louis, MO.

  • Prakash, R. (2024, Nov. 22). Gift of Life: Organ Donation in India Lags America. Retrieved from https://alotusinthemud.com/gift-of-life-organ-donation-in-india-lags-america/

  • United Network for Organ Sharing (2025). Can I be too old or too sick to receive a transplant? Retrieved from https://unos.org/transplant/frequently-asked-questions/#:~:text=The%20transplant%20team%20will%20discuss,cancer%20diagnosis%20or%20morbid%20obesity.