Nursing care plan TRANSPLANTATION CONSIDERATIONS POSTOPERATIVE AND LIFELONG

I. Procedure
a. Transfer of whole or partial organs—including heart, lung,
kidney, liver, pancreas, and intestines—and tissues or cells
from one location to another
b. Long considered experimental, heart and other transplant
procedures are successfully moving to domain of conventional
therapy; however, others, such as hand and limb
transplants, are still at the experimental stage
c. Bone, bone marrow, heart valve, cartilage, vein, pancreatic
islet, cornea, and stem cell transplantations are also performed
on a daily basis (Sharma & Unruh, 2006).
i. Stem cell use is being investigated for treating a wide
range of diseases, tissue damage, or both.
ii. Two types of stem cells: human embryonic stem cells
(hES) and adult somatic stem cells (ASSC), which is
the source currently being used (Sullivan &
Schoonover-Shoffner, 2007)
d. Major concerns (Workman, 2006)
i. Immunological response of the client to donor tissues and
the ability of the immune system to distinguish self from
nonself leading to rejection of the transplant
ii. Special considerations necessitate meticulous measures
to prevent infection and identify early signs of rejection.

II. Types—characterized according to the genetic relationship
between the donor and recipient or the anatomical site of the
implantation
a. Genetic relationship characterized into four classes (Sharma
& Unruh, 2006)
i. Autograft
ii. Isograft or syngeneic graft
iii. Allograft or homograft
iv. Xenograft or heterograft
b. Site of implantation (Sharma & Unruh, 2006)
i. Orthotropic: tissue implanted in the anatomically correct
position
ii. Heterotopic: relocation of the implant at a site different
from the normal anatomy

III. Statistics (U.S. Organ and Procurement Network [OPTN],
2006)
a. Morbidity: In 2006, 28,291 transplants were performed
in all categories—heart, lung, kidney, pancreas, liver,
intestine, and multi-organ—in the United States; kidney
transplant is the most common (greater than16,000),
followed by liver (greater than 6,000) and heart
(greater than 2,100).
b. Mortality: Dependent on type of transplant, level of match
and human leukocyte antigen (HLA) status, recipient’s
age at transplant, preoperative condition, presence of
comorbidities (Parimon et al, 2005); in 2005, the 90-day
mortality for a live donor kidney was 0.7%; intestinal
transplant, 8.6% (U.S. Department of Health and Human
Services [USDHHS], 2007).
c. Cost: Varies according to procedure; estimated average
first-year medical charges per transplant episode for
kidney, $246,400; heart, $658,800; intestine, $908,600
(Hauboldt, 2007).

Care Setting
Post-intensive care unit (ICU) plan of care addresses early
recovery and long-term postdischarge community or clinic
follow-up phases.

Related Concerns
Refer to (1) specific surgical plans of care for general considerations
(e.g., cardiac surgery) and (2) organ-specific plans
(e.g., heart failure, renal failure, cirrhosis, hepatitis) relative to
issues of target organ problems following transplantation.
Peritonitis
Psychosocial aspects of care
Sepsis/septicemia
Surgical intervention
Thrombophlebitis: deep vein thrombosis

Nursing Priorities
1. Prevent infection.
2. Maximize organ function.
3. Promote independent functioning.
4. Support family involvement and coping.

Discharge Goals
1. Free of signs of infection.
2. Signs of rejection absent or controlled.
3. New organ function adequate.
4. Usual activities resumed.
5. Client and family education plan established.
6. Plan in place to meet individual needs following discharge.
Risk factors

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