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ORGAN AND TISSUE

DONATION

AND

RECOVERY

DANA BARTLETT, BSN, MSN, MA, CSPI

Dana Bartlett is a professional nurse and author.

His clinical experience includes 16 years of ICU and

ER experience and over 20 years of as a poison

control center information specialist. Dana has

published numerous CE and journal articles,

written NCLEX material, written textbook chapters, and done editing and reviewing

for publishers such as Elsevire, Lippincott, and Thieme. He has written widely about

toxicology and was recently named a contributing editor, toxicology section, for

Critical Care Nurse journal. He is currently employed at the Connecticut Poison

Control Center and is actively involved in lecturing and mentoring nurses, emergency

medical residents, and pharmacy students.

ABSTRACT

Organ transplantation rates have increased in the past several decades

and yet nursing education with respect to the process of organ

donation and post transplant care has been inconsistent. Certain state

jurisdictions, such as New Jersey, are now requiring nurses to receive

continuing education on organ donation and transplantation to renew

their license to practice. The goal of mandatory education is to

increase nursing knowledge and participation in organ donation and

transplantation programs, and to advance the role of nurses in this

continuously growing area of health care.

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Policy Statement

This activity has been planned and implemented in accordance with

the policies of NurseCe4Less.com and the continuing nursing education

requirements of the American Nurses Credentialing Center's

Commission on Accreditation for registered nurses. It is the policy of

NurseCe4Less.com to ensure objectivity, transparency, and best

practice in clinical education for all continuing nursing education (CNE)

activities.

Continuing Education Credit Designation

This educational activity is credited for 1 hour. Nurses may only claim

credit commensurate with the credit awarded for completion of this

course activity.

Statement of Learning Need

Recent studies have shown that nurses' attitudes and advocacy to

discuss transplantation among colleagues and with others increased

following the appropriate education and practice support. Additionally,

when encouraged to participate in organ donation and transplantation

education, nurses demonstrated increased confidence in working with

transplant patients and in addressing the need to educate their

communities about organ donation, encouraging others to get involved

in local organ donation and transplantation programs.

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Course Purpose

This course will provide basic learning for nurses in the coordination of

organ donation and transplantation; and, to increase nursing advocacy

to increase the rates of organ donation in their local areas.

Target Audience

Advanced Practice Registered Nurses and Registered Nurses

(Interdisciplinary Health Team Members, including Vocational Nurses

and Medical Assistants may obtain a Certificate of Completion)

Course Author & Planning Team Conflict of Interest Disclosures

Dana Bartlett, BSN, MSN, MA, CSPI, William S. Cook, PhD,

Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC – all

have no disclosures

Acknowledgement of Commercial Support

There is no commercial support for this course.

Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article.

Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course.

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1. True or false: Registering as an organ donor or reviewing

information about organ donation is mandatory for obtaining a driver’s license in NJ.

a. True

b. False

2. Most organ donations are from:

a. Living donors b. Autologous donors

c. Deceased donors d. Xenogenic donors

3. Common complications associated with organ

transplantation include:

a. Transfusion reaction

b. Hyper-metabolic state c. Diabetes insipidus

d. Infection

4. Someone who is specifically allowed to discuss organ donation is a

a. Registered nurse

b. Designated requestor c. Transplant coordinator

d. UNOS representative

5. CBIGs are intended, in part, to:

a. Keep the donor patient comfortable until organs can be obtained.

b. Be diagnostic criteria for brain death. c. Help medical staff determine when to remove life support.

d. Ensure that potential donor organs are hemodynamically stable and perfused.

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Introduction

Organ and tissue donation and transplantation are life saving and life

altering therapies. From 1988 to August 2013 over 580,000 people in

the United States have received organ transplants, and the number of

donors has been slowly but steadily increasing. Tissue transplantation

is also quite common: approximately 750,000 are performed in the

United States every year. The increasing incidence of both donations

and transplants makes it imperative that nurses understand the

processes of how organs and tissues are obtained.

As of 2014, the New Jersey Board of Nursing requires every

professional registered nurse to complete a one-hour course that

covers organ and tissue donation and recovery. As organ donation and

transplantation is more complex than tissue donation and

transplantation (and in many ways the two procedures are carried out

in the same way) this learning module will primarily focus on organ

donation and transplantation.

Epidemiology and Statistics

The first successful organ transplant was performed in 1954. Since

that time, organ and tissue donation and transplantation have become

accepted treatments for a wide variety of diseases and medical

conditions. The three most commonly donated and transplanted

organs in descending order are kidneys, liver, and heart. The organs

that can and are transplanted also include intestines, lungs, and

pancreas and multiple transplants can be done, as well. Tissue

transplantation can be done with amnion, bone, bone marrow,

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connective tissue, cord blood, corneas, heart valves, ligaments,

ovarian tissue, pancreatic islet cells, skin, and veins. Most donated

organs are from the deceased.

Although the number of organ and tissue donations and

transplantations is increasing every year, the demand far exceeds the

supply. There are more than 120,000 people on the transplant waiting

list; in 2016 (to date) there have been almost 28,000 transplants

performed, and each day 22 people die that a transplant could have

saved. In New Jersey in 2015, 531 transplants were performed.

However, almost 2700 people in the state are on the waiting list, and

waiting for an organ is a long process. In the United States the median

waiting time for a kidney is 5.1 years and the situation is similar in

New Jersey. In 2016, some people in New Jersey have been waiting

for a kidney transplant for five years and longer.

Transplants and donations are well established in New Jersey, but

there is a critical lack of registered donors. New Jersey ranks number

44 out of the 50 states in the percentage of registered organ and

tissue donors, and only one-third of New Jersey drivers are registered

as organ donors. Efforts have been made to increase the number of

donors. New Jersey drivers must register through Donate Life NJ

(http://donatelifenj.org/) as someone that is an organ donor or review

information about organ donation when applying for, or renewing a

driver’s license; however, the need for organ donation is still not being

met. As a tissue donation can affect the lives of 50-75 people and one

organ donor can save the lives of eight people, the need to increase

participation is painfully clear.

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Basics Of Organ And Tissue Donation And Transplantation

Organ donation and transplantation can be divided into many different

categories.

Donation from deceased donors:

This is the most common type of organ donation.

Donation from living donors:

A donation from a living donor offers several advantages. This

approach increases the possible pool of donors. It allows for a

thorough evaluation of the donor and the recipient and planning or

organization of the surgery. And a living donor also provides an organ

that is usually well perfused.

Allogenic donation:

An allogenic donation is the donation of an organ from another person.

Isogenic donation:

The organ is donated from an identical twin.

Autologous donation:

Tissue is transplanted from one site in the body to another. Autologous

blood donations are relatively common.

Xenogenic donation:

The organ or tissue has been harvested from another species, i.e.,

heart valves from pigs.

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Donation after brain death:

Donation after brain death is performed with an organ from someone

who meets the criteria for brain death. These donations usually offer

an organ that is well perfused. Also, these donors can donate multiple

organs, such as, heart, both lungs, both kidneys, liver, pancreas, and

the small intestine.

Donation after cardiac death:

Donation after cardiac death increases the pool of possible donors and

has been, in part, an answer to the shortage of organs available for

transplantation. Transplantation of kidneys, liver, and lungs after

cardiac death is well established and in many cases the outcome for

these procedures is comparable to transplants using organs from

patients that suffered brain death. The most pressing issue in organ

donation after cardiac death is organ ischemia. The implications or

consequences of ischemia for the transplant process are still being

investigated.

Tissue Donation and Transplantation

Tissue donation and transplantation is performed in much the same

way as is solid organ donation and transplantation. However, the types

of tissues that can be used are more numerous, and composite

transplantation - transplantation of several tissue types in one

procedure - can also be performed.

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Donation and Transplantation Complications and Risks

The most common complications and risks associated with donation

and transplantation are: 1) Rejection, 2) Infection, 3) Increased risk of

disease, and 4) Adverse effects of immunosuppressive drugs.

Rejection:

Rejection can be soon after transplant or many months later.

Immunosuppressive drugs reduce the rate of rejections, but acute

rejection rate for kidney transplants is still approximately 10-15% and

15-25% for liver transplants.

Infection:

Opportunistic infection after transplantation and infection from the

transplanted organ can be from a wide variety of pathogens, including

(but not limited to) tuberculosis and other bacteria, Clostridium,

cytomegalovirus, HCV, hepatitis E, herpes, Epstein-Barr virus,

parovirus, rabies, group A streptococci, Candida albicans and molds.

The overall risk of infection associated with transplantation is very

small, probably < 1%, but for some procedures, i.e., kidney

transplantation, it is common. However, surveillance for and reporting

of post-transplant infections is not ideal so the actual number of

infections is not known. In addition, there are no universally agreed

upon protocols for screening of organ or tissue donors.

Donors who have infectious diseases such as hepatitis B, hepatitis C,

encephalitis, meningitis, pneumonia, tuberculosis, and other infectious

conditions can be considered as donors if informed consent from the

recipient is obtained and therapy and follow-up are possible.

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Increased risk of disease:

People who have had a transplant are at increased risk for developing

bone disease and orthopedic problems, cancer, heart disease, and

other medical problems.

The Process Of Organ And Tissue Transplantation

The process of organ donation is usefully divided into the following

steps: 1) Referral, 2) Evaluation, 3) Family discussion, and

4) Recovery and allocation. The process of organ and tissue

transplantation starts with a referral. Suitable cases are referred to the

local Organ Procurement Organization (OPO); and, there are two in

New Jersey.

New Jersey Sharing Network:

The New Jersey Sharing Network operates in northern and central New

Jersey in Bergen, Essex, Hudson, Hunterdon, Mercer, Middlesex,

Morris, Monmouth, Ocean, Passaic, Somerset, Sussex, Union, and

Warren counties. Their 24-hour telephone number is 1-800-742-7365.

Their website address is http://www.njsharingnetwork.org/contact.

Gift of Life Donor Program:

The Gift of Life Donor Program operates in southern New Jersey in

Atlantic, Burlington, Camden, Cape May, Cumberland, Gloucester, and

Salem counties. Their 24-hour telephone number is 1-800-KIDNEY-1.

The website address is http://www.donors1.org/.

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Referral for Organ Donation

The referral for organ donation starts with identification of a patient’s

clinical situation in which organ donation may be likely or could be a

possibility. These situations are recognized by the presence of

imminent death and clinical triggers. Federal regulations require that

hospitals contact the local OPO about all patients that have died or are

near death - imminent death. When the OPO has been contacted, it

will start the process of evaluation and, possibly matching of donor to

recipient. It was in the federal regulations that hospitals develop a

definition of imminent death, and this definition is usually:

1. A patient with acute, severe, brain injury who requires

mechanical ventilation

2. A patient who is being evaluated for brain death

3. The presence of certain clinical findings

The clinical findings that are used most often are: 1) A Glasgow Coma

Scale of ≤ 5; and, 2) The absence of two or more cranial reflexes, i.e.,

caloric response, cough/gag reflex, corneal reflex, failure to respond to

pain, pupillary response to light, etc. The Glasgow Coma Scale and the

cranial reflexes are used because they have a high degree of inter-

observer reliability and they correlate well with outcome, i.e., the

lower the Glasgow Coma Scale and the fewer intact cranial reflexes the

worse the outcome is likely to be. Taken as a whole, the conditions 1

and 2 listed above and the clinical findings are referred to as clinical

triggers. The clinical triggers are identified in cases in which the

patient is critically ill and near death, and identify patients that may be

donor candidates because they are likely to die or progress to brain

death.

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These clinical triggers may vary from hospital to hospital and between

different OPOs. It is also considered necessary to contact the OPO

prior to discussing organ donation with the patient’s family. In the

case of a death and possible organ or tissue donation, the referral

must be made within an hour of the death. Donations can be made

from a patient who has been declared brain dead or from a patient

who has suffered cardiac death. If a patient has suffered a non-

survivable injury but does not meet the criteria for brain death, the

decision may be made to remove the patient from life support, and

this would be considered donation after cardiac death. If this happens,

organ donation is a possibility.

Evaluation

A donation specialist from an OPO does the evaluation of a patient and

the clinical situation for the possibility of organ donation. Once the

OPO has been contacted about a potential donor, the evaluation

specialist will immediately go to the hospital. The evaluation specialist

will examine the patient’s medical record, tests for infectious diseases

may be ordered, and a decision will be made as to whether or not

organ donation is possible. If the patient was enrolled in the state

registry as a donor, that registration is considered to be the legal

consent for the donation. If the patient was not registered as a donor

and the patient’s driver’s license did not indicate that he/she wished to

be a donor, family or next of kin will be contacted.

Viability of organs is obviously a critical concern in the donation

process. Unfortunately, the majority of donated organs come from

people who are brain dead and these organs are less viable than

organs from living donors. In addition, many people who have suffered

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brain death are physiologically and hemodynamically unstable,

decreasing the potential for maintaining organs in a condition suitable

for transplant.

In response to this issue, OPOs and hospitals have adopted the use of

catastrophic brain injury guidelines (CBIGs) in the evaluation process

of organ donation. Catastrophic brain injury guidelines (CBIGs) are

recommendations used to treat people who: 1) Have suffered a

catastrophic brain injury; and, 2) Have been assessed by a neurologist

and a neurosurgery specialist as having a non-survivable neurological

injury or neurologic death. These guidelines are intended to ensure

hemodynamic stability and tissue perfusion. In this way, the patient’s

clinical progress as it would naturally evolve can be observed and end-

of-life decisions can be made. As viability of organs is obviously a

critical issue in the donations process, these CBIGs are also used if the

patient is deemed to be a potential organ donor, and they have been

shown to help OPOs and hospitals increase the number and quality of

donated organs.

The CBIGs listed below are from the New Jersey Organ and Tissue

Sharing Network clinical resources section website.

1. Make sure the patient is adequately hydrated and euvolemic.

2. Maintain systolic blood pressure of >100 mm Hg (MAP >60 mm

Hg). If needed, neosynephrine up to 2 mcg/kg/minute is the

vasopressor of choice, followed by dopamine if needed. Consider

using invasive hemodynamic monitoring.

3. Maintain urine output of >0.5 ml/k/hour, < 400 mL/hour. If the

urine output is < 0.5 mL/kg/hour, assess the patient’s fluid

status and rehydrate or consider blood pressure support.

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4. Consider the possibility of diabetes insipidus if the urine output is

> 4000 mL/hour x two hours.

5. Treat diabetes insipidus with vasopressin, 1-2.5 mcg/hour. If the

urine output is still >400 mL/hour after vasopressin, give DDAVP

0.5 mcg IV bolus every 2-3 hours.

6. Ensure adequate oxygenation and acid-base balance: Maintain

the PO2 at >100 mm HG, and maintain pH between 7.35-7.45.

PEEP of 5-8 may be needed.

7. Use aggressive respiratory hygiene if not contraindicated by

patient’s condition, i.e., suction and turn every 2 hours,

respiratory therapy treatments to prevent bronchospasm.

8. Maintain temperature between 36-37.5°C

9. Maintain normal values for coagulation/clotting, complete blood

count, electrolytes, and glucose. Normal blood values and

treatment recommendations for specific blood ranges are:

• Sodium: 134-145 mmol/L

• Potassium: 3.5 – 5.0 mmol/L

• Magnesium: 1.8 - 2.4 meq/L

• Phosphorus: 2.0 - 4.5 mg/dL

• Ionized Calcium: 1.12 - 1.3 mmol/L

• Maintain glucose between 80-200 mg/dL and use an

insulin infusion rather than subcutaneous injections for

control of glucose.

• Monitor and treat Hgb/Hct/Coagulation factors (especially

if GSW or other penetrating head injury)

• Maintain Hgb >8.0 g/dL and Hct >24%

• If PT >18.0 give 2u FFP

• If fibrinogen 70 - 100 give 2u FFP, if < 70 give

cryoprecipitate

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• If platelets < 50 give 6pk of platelets

The CBIGs will vary from place to place. For example, some OPOs and

hospitals will recommend that the patient be maintained on all

medications he/she was receiving prior to the application of the CBIGs

and that hemodynamic monitoring be used. Tissue matching and blood

typing are an important part of the evaluation process. Blood will be

tested to determine ABO and Rh type, a cross-match between donor

and recipient will be performed, and human leukocyte antigen (HLA)

testing will be done, as well red blood cell antibodies

Family Discussion

The transplant coordinator or evaluation specialist will meet with the

potential donor’s family to discuss the donation procedure. If the

patient had already indicated an intention to donate by registering as a

donor, then in most instances this is considered the only authorization

that is needed and this process may be relatively brief. If the patient

had not expressed a preference, then certainly more time will be

needed. If the procedure is to be a living donation, then obviously, a

family discussion is not needed. It is a requirement that anyone who

approaches a family regarding organ donation must have special

training as a designated requestor.

Recovery and Allocation

The patient is maintained according to an organization’s protocol until

it has been decided to obtain the organs. If life support is removed, as

in donation after cardiac death, the organs must be removed within 90

minutes of extubation. Once the patient has expired, the organs and

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tissues are recovered. The transplant coordinator will be working with

the Organ Procurement and Transplant Network (OPTN) and local

transplant surgeons to find the best match for the donation. The OPTN

is explained as follows:

“… the unified transplant network established by the United

States Congress under the National Organ Transplant Act

(NOTA) of 1984. The act called for the network to be operated

by a private, non-profit organization under federal contract. The

primary goals of the OPTN are to increase the effectiveness and

efficiency of organ sharing and equity in the national system of

organ allocation, and to increase the supply of donated organs

available for transplantation. The United Network for Organ

Sharing (UNOS) ... administers the OPTN under contract with the

Health Resources and Services Administration of the U.S.

Department of Health and Human Services.”

The OPTN, working through UNOS, collects, stores, and analyzes

information that pertains to donors and recipients: donor/recipient

matching, deceased and living donors, and potential recipients, the

patient waiting list, and other information such as name, gender, race,

age, height, weight, medical history, ABO blood group, peak and

current panel reactive antibody (PRA) levels, HLA data, and acceptable

donor characteristics. Race, gender, income, and social status are not

included in the database. When an organ becomes available a

computer program compares information about the donor with

recipient information in the database. The transplant coordinator and

the OPTN will be reviewing all this information about potential

recipients and the donors. Their work and the input of a

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histocompatability laboratory and a transplant team will be

coordinated and, hopefully, an allocation and a match will be made.

Summary

Organ and tissue donation and transplantation are life saving and life

altering therapies, and nurses have a key role in educating their

communities about the existing health need to help save lives.

Despite the rise in need, there remains a critical lack of registered

organ donors that some states, such as New Jersey, are addressing

through mandatory education for nurses and local public programs.

The various organ donation and transplantation steps are supported

through regulatory agencies and healthcare policies, which include

centralized databases and specially trained support staff. Through local

awareness campaigns, such as Save A Life, potential donors may be

informed and take steps to begin the process of helping to save a life,

which begins with the proper referral through to the right

donor/recipient match.

Please take time to help NurseCe4Less.com course planners

evaluate the nursing knowledge needs met by completing the self-assessment of Knowledge Questions after reading the

article, and providing feedback in the online course evaluation.

Completing the study questions is optional and is NOT a course requirement.

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1. True or false: Registering as an organ donor or reviewing

information about organ donation is mandatory for obtaining a driver’s license in NJ.

a. True

b. False

2. Most organ donations are from:

a. Living donors b. Autologous donors

c. Deceased donors d. Xenogenic donors

3. Common complications associated with organ

transplantation include:

a. Transfusion reaction

b. Hyper-metabolic state c. Diabetes insipidus

d. Infection

4. Someone who is specifically allowed to discuss organ donation is a

a. Registered nurse

b. Designated requestor c. Transplant coordinator

d. UNOS representative

5. CBIGs are intended, in part, to:

a. Keep the donor patient comfortable until organs can be obtained.

b. Be diagnostic criteria for brain death. c. Help medical staff determine when to remove life support.

d. Ensure that potential donor organs are hemodynamically stable and perfused.

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Correct Answers:

1. True or false: Registering as an organ donor or reviewing information about organ donation is mandatory for

obtaining a driver’s license in NJ.

a. True

“New Jersey drivers must register through Donate Life NJ (http://donatelifenj.org/) as someone that is an organ donor or

review information about organ donation when applying for, or renewing a driver’s license…”

2. Most organ donations are from:

c. Deceased donors

“Most donated organs are from the deceased.”

3. Common complications associated with organ

transplantation include:

d. Infection

“The most common complications and risks associated with

donation and transplantation are: 1) Rejection, 2) Infection, 3) Increased risk of disease, and 4) Adverse effects of

immunosuppressive drugs.”

4. Someone who is specifically allowed to discuss organ donation is a

b. Designated requestor

“It is a requirement that anyone who approaches a family regarding organ donation must have special training as a

designated requestor.”

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5. CBIGs are intended, in part, to:

d. Ensure that potential donor organs are hemodynamically stable

and perfused.

“In response to this issue, OPOs and hospitals have adopted the use of catastrophic brain injury guidelines (CBIGs) in the

evaluation process of organ donation. Catastrophic brain injury guidelines (CBIGs) are recommendations used to treat people

who: 1) Have suffered a catastrophic brain injury; and, 2) Have been assessed by a neurologist and a neurosurgery specialist as

having a non-survivable neurological injury or neurologic death. These guidelines are intended to ensure hemodynamic stability

and tissue perfusion.”

References Section

The References below include published works and in-text citations of

published works that are intended as helpful material for your further reading.

1. Am J Transplant. Special Issue: OPTN/SRTR Annual Data Report

2014. Am J Transplant. 2016;16(S2):4-215. 2. Bestard O, Cravedi P. Monitoring alloimmune response in kidney

transplantation. J Nephrol. 2016 May 31. [Epub ahead of print]. 3. Cotler SJ. Treatment of acute cellular rejection in liver

transplantation. UpToDate. June 30, 2015.

http://www.uptodate.com/contents/treatment-of-acute-cellular-rejection-in-liver-transplantation. Accessed November 22, 2016.

Degnan KO, Blumberg EA. 4. Human immunodeficiency virus in kidney transplantation. Semin

Nephrol. 2016;36(5):405-416.Eren EA, Latchana N, Beal E, Hayes D Jr, Whitson B, Black SM. Donations after circulatory death in

liver transplant. Exp Clin Transplant. 2016 Oct;14(5):463-470 5. Hart, A., Salkowski N, Snyder JJ, Israni AK, Kasiske BL. Beyond

"median waiting time": Development and validation of a competing risk model to predict outcomes on the kidney

transplant waiting list. Transplantation. 2016;100(7):1564-1570. 6. Hortlund M, Arroyo Mühr LS, Storm H, Engholm G, Dillner J,

Bzhalava D. Cancer risks after solid organ transplantation and

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after long-term dialysis. Int J Cancer. 2016 Nov 21. doi:

10.1002/ijc.30531. [Epub ahead of print] 7. Iyer A, Chew HC, Gao L, et al. Pathophysiological trends during

withdrawal of life support: Implications for organ donation after circulatory death. Transplantation. 2016;100(12):2621-2629

8. Kueht ML, Cotton RT, Galvan NT, O'Mahony CA, Goss JA, Rana A. Profiling immunologic risk for acute rejection in liver

transplantation: Recipient age is an important risk factor. Transpl Immunol. 2016 Sep;38:44-9.

9. Kwon H, Kim YH, Choi JY, et al. Analysis of 4000 kidney transplantations in a single center: Across immunological barriers.

Medicine (Baltimore). 2016 Aug;95(32):e4249. doi: 10.1097/MD.0000000000004249.

10. Liu S, Pang Q, Zhang J, Zhai M, Liu S, Liu C. Machine perfusion versus cold storage of livers: a meta-analysis. Front Med. 2016

Nov 11. [Epub ahead of print]

11. New Jersey Organ and Tissue Sharing Network. https://www.njsharingnetwork.org/. Accessed November 21,

2016. 12. Nin M, Coitiño R, Kurdian M, et al. Acute antibody-mediated

rejection in kidney transplant based on the 2013 Banff Criteria: Single-center experience in Uruguay. Transplant Proc.

2016;48(2):612-615. 13. Scalea JR, Sollinger HW. Only time will tell: The future of donation

after circulatory death. Exp Clin Transplant. 2016;14(Suppl 3):27-31.

14. Skov Dalgarrdt, Norgarrd, Povlsen JV, et al. Risk and prognosis of bacteremia and fungemia among first-time kidney transplant

recipients: a population-based cohort study. Infect Dis (Lond). 2016 Nov 8:1-10.

15. van Loo ES, Krikke C, Hofker HS, Berger SP, Leuvenink HG, Pol

RA. Outcome of pancreas transplantation from donation after circulatory death compared to donation after brain death.

Pancreatology. 2016 Nov 7. pii: S1424-3903(16)31229-7. doi: 10.1016/j.pan.2016.11.002. [Epub ahead of print]

16. US Department of Health and Human Services: Organ Donation Statistics. http://organdonor.gov/statistics-stories/statistics.html.

Accessed November 21, 2016. 17. US Department of Health and Human Services. Organ and

Transplantation Procurement Network. State Data. https://optn.transplant.hrsa.gov/data/view-data-reports/state-

data/. Accessed November 21, 2016. 18. West, S., Soar J., Callaway CW. The viability of transplanting

organs from donors who underwent cardiopulmonary

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resuscitation: A systematic review. Resuscitation. 2016;108:27-

33. 19. Yuan X, Chen C, Zhou J, et al. Organ donation and transplantation

from donors with systemic infection: A single-center experience. Transplant Proc. 2016;48(7):2454-245.

20. Nin M, Coitiño R, Kurdian M, et al. Acute antibody-mediated rejection in kidney transplant based on the 2013 Banff Criteria:

Single-center experience in Uruguay. Transplant Proc. 2016;48(2):612-615.

The information presented in this course is intended solely for the use of healthcare

professionals taking this course, for credit, from NurseCe4Less.com. The information

is designed to assist healthcare professionals, including nurses, in addressing issues

associated with healthcare.

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