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Managing transplant

on Thu, 08/09/2012 - 02:28
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which transplant is most difficult to manage and why?

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Haley Hoy's picture

Keeping in mind, all transplants are delicate situations for the patient, family, and medical staff to manage appropriately and postoperative problems lurk around every corner. Numerous obstacles are presented to the patients, but they seem to be strongly motivated from the long awaited arrival of this life-saving procedure. It gives them a second chance and they are willing to accept the the challenges they face.
            I stand fast on the principle of lung transplantation as being the most difficult to manage for many reasons. First, the lungs are so susceptible to infection due to the immunological functions of these organs and the opportunistic organisms that may plague them. Healthy people face many pulmonary issues throughout the year and I can only imagine the exponential amount of problems that post transplant lung patients are up against. Every day they are challenged with the fear that infection or rejection may be the next message they hear from a medical provider. They are also learning daily to protect, nurture, and follow-up precisely on information they need to keep their prized organs functioning properly. To them it is life or death, and their options are severely limited.
            Many disciplines are involved in the transplant team. Nurse, physicians, physical therapists, respiratory therapists, social services, case management, and you might just say the entire health care team. It takes a special effort to coordinate the care a post transplant patient needs, and we must challenge ourselves to step up to the plate. This is an ongoing field of medicine that has come a long way and continues to grow in knowledge and skill. I hope to be involved in the area of transplantation and be able to experience the wonderful excitement a patient must feel when they are told, “We have a ________ for you.” The odds and statistics are many times stacked against them but faith and determination of survival is what makes them special.

Susan Alexander's picture

While I believe all transplant patients are difficult to manage for their own individual complications, lung transplants seem to be the most complicated and in-depth. I had originally thought pancreas transplant patients were the most difficult to manage for there being no clear method to determine early rejection, however; after reading the lung chapter, I was amazed at what these patients must endure. Care of these patients truly is a multidisipline approach an everyone must be on the same page. The concept of single and double lumen ET tubes and using 2 ventilators was something I had never thought of before. After having it explained, it makes sense as to why this must occur in certain patients. It is known that CMV is hazardous in all transplant patients but it is particularly lethal in these patients. It is shown to be paired with the development of obliterative bronchiolitis which is an indication for lung transplant itself. With the scarcity of donor lungs available, patients who develop obliterative bronchiolitis must be devastated to learn that the most definitive treatment for this condition would be another transplant. This would mean another round of the waiting game. With all the complications that can occur after lung transplantation, the entire healthcare team must input their expertise into managing these unique patients.

mmaskey's picture

After reading about the topic at hand I have drawn a conclusion that lung transplants would be the most difficult to manage. They pose a threat for a high rejection rate, and carry many risk factors for complications such as infection including bacteria, fungal and viral. This does not go without saying that the lungs are at the same risk as they usually are after sugery which are: pulmomary edema, pulmonary embolism, pneumonia, atelectasis; just to name a few. The biggest threat is bronchiolitis obliterans syndrome, being one the leading causes of death during the first year. Other organs can be affected after lung transplant, thus further complicating and decreasing the chance of survival. They include but are not limited to: renal failure, DM, HTN and hyperlipidemia. Venous thromboembolism disease, which includes deep venous thrombosis and pulmonary embolism, has an increased incidence in lung transplant recipients as well.