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Conveying useful healthcare system information, including for organ donation and transplantation, as well as a social media emphasis.

Saturday, June 16, 2012

The Most Important Transplant Surgeon Conversation- Providing an Outline of the Transplant Surgical Procedure

The  most important conversation that a transplant surgeon needs to have with any potential recipient relates to the planned transplant surgical procedure. This involves describing what the actual procedure involves, as well as any potential problems that can occur with the surgery followed then by the expected post-operative course.

All transplant surgical procedures are considered major operative procedures and there are common elements which they all share-

a)     Making an appropriate incision either on the chest or the abdomen to gain the required access

b)    The surgical removal of the recipients own diseased organ in the case of the lungs, liver and heart in order to make space for the new organ to be transplanted. This also requires that some blood vessels and other structures need to be preserved to assist with the next phase of the surgery.

c)    Implanting the new donor organ which involves suturing a number of vessels and other pipes/structures that are specific to each type of donor organ

d)    Ensuring that any other problems such as bleeding are then dealt with

e)    Inserting drainage tubes and closing the incision

 Once the surgery is completed one of two things then happens-

1)    In the case of kidney recipients, most of the time the patient can be woken up from the anaesthetic and transferred to a ward or step-down unit for close post-operative monitoring to occur

2)    For the heart, lung and liver recipients most patients are kept asleep at the end of the surgery and transferred straight from the operating room to the intensive care unit for ongoing close monitoring. This is required until it is apparent that the patient is stabilising following the surgery and that the newly transplanted organ is functioning.

The nature of the surgery and the expected post-operative course can generate many other questions. There are some general guides available including via the Internet. In particular via the MedlinePus site in the United States-  Liver transplantation heart transplantation kidney transplantation  lung transplantation

The pieces of information that need to be put together for every transplant recipient including the last piece of information that can be obtained only during the actual transplant procedure.

However both the magnitude of the surgery as well as the range of possible complications do vary depending on both the organ being transplanted and how unwell each potential recipient is at the time of the transplant procedure -

       a) How each transplant recipient fares during the surgery and early on post operatively is   
           related to the many specific bits of information that need to be put together at the time-as 
           outlined in the above image.  

      b)  It is important to remember that the last 2 pieces of the recipient information jigsaw 
           puzzle are only able to be put together in the operating room during the actual transplant   
           surgery. For example there is no test for how much scarring may be present in the 
           abdomen in a liver recipient who has undergone previous surgery, hence this can only be 
           determined during the actual transplant surgical procedure. 

      c) Also if the combination of all of the non-surgical pieces of information were to predict an 
          unfavourable outcome in advance for a recipient, then the transplant surgery would not be 
          able to go ahead.

Hence specific advice should be sought by potential transplant patients and their relatives from the transplant programme that they are currently in contact with. There are both pluses and minuses from currently seeking health care advice only via the Internet as outlined via the following link- Mashable- what-doctors-think-about-your-online-health-searches

Image designed by Deb Verran 2012: acknowledgement Presentation magazine