CKD/ESRD

&
Management
“Bones can break, muscles can atrophy,
glands can loaf, even the brain can go to
sleep without immediate danger to
survival. But -- should kidneys fail....
neither bone, muscle, nor brain could
carry on”.
-Homer Smith, Ph.D.

2
 REVIEW
 Recall functions of the kidneys?

 Recall normal creatinine & BUN; other lab

tests?

 Review Diagnostic Tools

 CKD- Elderly Risk (Review)
•Older Adult-normal aging (plus co-morbidities) > risk kidney dysfunction/renal failure
•Must:

•Identify/prevent damage
•Monitor/risk multiple RX/OTC meds (altered renal blood flow/dec. renal
clearance etc)
•Monitor/risk associated with dehydration (ie diuretics)
•Monitor/risk with dec ability to respond to changes to fluid/electrolyte
status (manifestation may be atypical
 Functions of the Kidneys

 Regulates volume and  Vitamin D activation

composition of
extracellular fluid
 Acid-base balance
(HCO3 & H) regulation
 Excretion of nitrogenous
through process of
waste products _____, ____ and ______.
 BP control via renin-  Prostaglandin synthesis
filtration, secretion,
angiotensin-aldosterone reabsorpton
 Erythropoietin
system- Recall RAAS
production
 Functions of the Kidneys
(cont)
 Erythropoietin Release
 If a patient has chronic renal failure, what
condition will occur?
 WHY???

EPO- glycoprotein hormone that controls

erythropoiesis, or red blood cell production

6
 Diagnostic Tools for
Assessing Renal Failure
 Blood Tests
 BUN elevated (norm 10-20 mg/dl) (text 10-30mg/dl)
 Creatinine elevated (norm 0.6 - 1.2 mg/dl) (text 0.5-
1.5mg/dl)
 K elevated (text norm 3.5-5.0 mEq/L)
 PO4 elevated (text norm 2.8-4.5mg/dl)
 Ca decreased (text norm 9-11mg/dl)
 Urinalysis
 Specific gravity (text norm 1.003-1.030
 Protein (text norm 0-trace)
 Creatinine clearance (text norm 85-135ml/min)

7
 BUN
 Normal 8 - 20 mg/dl (text 10-30mg/dl)
 Nitrogenous waste product of protein
metabolism
 Unreliable in measurement of renal function
 Relevance assessed in conjunction with serum
creatinine

8
 Creatinine
 A waste product of muscle metabolism
 Normal value 0.6 - 1.2 mg/dl (text 0.5-
1.5mg/dl)
 2 times normal = 50% damage
 8 times normal = 75% damage
 10 times normal = 90% damage
 Exception - severe muscular disease can greatly 
serum creatinine levels

9
 Diagnostic Tools
 Ultrasound
 X-Rays
 Biopsy *most definitive

10
 Chronic Renal Failure/
Chronic Kidney Disease (CKD)
 Slow progressive renal disorder related to
nephron loss, occurring over months to years

 Culminates in End Stage Renal Disease

(ESRD)

11
 Characteristics of CKD > ESRD

 Cause & onset often unknown

 Loss of function precedes lab abnormalities
 Lab abnormalities precede symptoms
 Symptoms (usually) evolve in orderly sequence
 Renal size is usually decreased

12
 Causes of CKD
 *Diabetes
•Neoplasms
 *Hypertension •Obstructive disorders
 Glomerulonephritis •Autoimmune diseases
 Cystic disorders (lupus)
 Developmental - •Hepatorenal failure
Congenital •Scleroderma
•Amyloidosis
 Infectious Disease
•Drug toxicity-(overuse some
common drugs, as aspirin, NSAID as
ibuprofen, cocaine and
acetaminophen)
NSAIDs-…cause prerenal ARF by blocking prostaglandin production > also alters
local glomerular arteriolar perfusion… (reduces renal blood flow)

13
Glomerular Filtration Rate (GFR)-determine stage
CKD (most accurate evaluation)

 24 hour urine for creatinine clearance

 Formula- urine creatinine X urine volume
 serum creatinine
 Can estimate creatinine clearance by:
140 – {age x weight (kg)}
72 x serum creatinine

 What is normal GFR?

90 - 120 mL/min
14
Stages of CKD (“old”
terminology)
 Reduced Renal Reserve
 Renal Insufficiency
 End Stage Renal Disease (ESRD)

15
 Stages of CKD
NKF Classification System

Stage 1: GFR > 90 ml/min despite kidney

damage
Stage 2: Mild reduction (GFR 60 – 89
ml/min)
1. GFR of 60 may represent 50%
loss in function.
2. Parathyroid hormones starts to
increase. (why?)
*kidneys unable to reabsorb calcium, blood calcium levels fall,
stimulating continual secretion of parathyroid hormone to maintain
normal calcium levels in blood.
16
 During Stage 1 - 2
 No symptoms

FYI-older adult- may

 Serum creatinine doubles* impaired renal function even in
presence of normal serum

(Up to 50% nephron loss

 creatinine

17
 Stages of CKD
NKF Classification System

Stage 3: Moderate reduction (GFR 30 – 59

ml/min)
1. Calcium absorption decreases
(from the GI tract)
2. Malnutrition onset
3. Anemia
4. Left ventricular hypertrophy

18
 Stages of CKD
NKF Classification System

Stage 4: Severe reduction (GFR 15 – 29

ml/min)
1. Serum triglycerides
2. Hyperphosphatemia
3. Metabolic acidosis
Oops- 4. Hyperkalemia
trouble!

K Effect & EKG

19
 During Stage 3 - 4

 Signs and symptoms worsen if kidneys stressed

 ability to maintain homeostasis
 75% nephron loss
 glomerular filtration rate, solute clearance,
ability to concentrate urine and secrete hormone
 Symptoms: BUN & Creatinine, mild
azotemia, anemia
20
 Stages of CKD-NKF Classification System
Stage 5: Kidney failure (GFR < 15 ml/min) ESRD!!!

 Azotemia

 Residual function < 15% of normal

 Excretory, regulatory, hormonal functions severely

impaired
 Metabolic acidosis (Kussmaul breathing)

 Marked : BUN, Creatinine, Phosphorous

 Marked : Hemoglobin, Hematocrit, Calcium

 Fluid overload

21
 During Stage 5
 Uremic syndrome develops- affecting all body
systems
 can be diminished with early diagnosis & treatment
 Last stage of progressive CKD
 Fatal if no treatment

22
 Manifestations of Chronic
Uremia
Syndrome-
combination
of common
symptoms
*greater
build-up
waste
products =
greater
symptoms

Fig. 47-5

23
What happens when kidneys
don’t function correctly?

24
 Manifestations of CKD -
Nervous System
 Mood swings
 Impaired judgment
 Inability to concentrate and perform simple math
functions
 Tremors, twitching, convulsions
 Peripheral Neuropathy
 restless legs

 foot drop
Manifestations due to inc nitrogenous waste products, electrolyte imbalances, metabolic
acidosis and axonal atrophy and demyelination of nerve fibers & dec erythropoietin*

25
 Manifestations of CRF
Skin
 Pale, grayish-bronze color
 Dry scaly
 Severe itching
 Bruise easily, petechiae, ecchymosis
 *Uremic frost
*Manifestations due to…calcium-phosphate deposition in skin, sensory
neuropathy, platelet abnormalities; urea crystallizes (uremic frost) >if
BUN extremely high

26
 Medical Mystery? What do lab studies, etc indicate ? What causes uremic frost?

*57-year-old with HTN and CKD (Stage 5), refused dialysis found in respiratory distress after week
of upper respiratory symptoms due to viral infection

Before admission to hospital >developed asystolic cardiac arrest, was resuscitated by EMT, admitted to ICU,
required vasopressor support.

PE- diffuse deposits tiny white crystalline material on skin > lab studies- BUN 208 mg/dl; creatinine 15 mg/dl;
bicarbonate level 5 mmol per liter; anion gap-26; arterial pH of 6.74, and arterial partial pressure of carbon
dioxide of 50 mm Hg. Blood cultures- revealed-Staphylococcus aureus pneumonia, likely due to prior
Walsh S and Parada N. N Engl J Med 2005;352:e13
influenza infection. *Aggressive care measures withdrawn after consultation with patient's family >patient
died.

*Uremic frost- uncommon skin manifestation due to profound azotemia;

occurs when urea and other nitrogenous waste products accumulate in sweat
and crystallize after evaporation.
 Manifestations of CKD
Eyes
 Visual blurring
 Occasional blindness
 “Red eye”

Due to calcium-phosphate deposits

in eyes

28
 Manifestations of CKD
Fluid - Electrolyte - pH
 Volume expansion and fluid overload
Due to impaired kidneys unable to excrete acid load (mostly
 Metabolic Acidosis from NH3); defective reabsorption/regeneration of HCO3.
 Electrolyte Imbalances
Due to dec excretion by kidneys, breakdown of cellular
 Potassium protein, bleeding, metabolic acidosis, food, drugs, etc

 Magnesium Kidneys unable to excrete (too much magnesium

causes hyporeflexia and can lead to cardiac arrest)

 Sodium Kidneys retain > water retention> fluid overload

29
 Manifestations of CKD
GI Tract/Bleeding Risk
 Uremic fetor
 Anorexia, nausea, vomiting
 GI bleeding Due to GI irritation, platelet defect; diarrhea from hyperkalemia
 Anemia
 Platelet dysfunction
Anemia-due to insufficient production of erythropoietin, protein
naturally produced in functioning kidneys…circulates through
bloodstream to bone marrow, stimulating production of RBCs.

Platelet dysfunction-subnormal platelet aggregation -due to fibrinogen fragments,

usually absent in normal human blood but present in uremic plasma may lead to
platelet dysfunction in uremia.

30
 Manifestations of CKD-Musculoskeletal

 Muscle cramps
 Soft tissue calcifications
 Weakness
 Related to calcium phosphorous imbalances
 RENAL OSTEODYSTROPHY
 Fracture risk!

31
 Manifestations of CKD- Heart & Lungs

 Hypertension
 Heart failure > pulmonary edema
 Pericarditis due to uremia
 Pulmonary edema
 Pleural effusions- “Uremic Lung”
 Atherosclerotic vascular disease*
 Cardiac dysrhythmias (from HF, electrolyte
imblaances)
*Major Problem!

32
Manifestations of CKD- Endocrine -
Metabolic
 Erythropoietin
 Hypothyroidism
 Insulin resistance
 Growth hormone
 Gonadal dysfunction
 Parathyroid hormone and Vitamin D 3
 Hyperlipidemia

33
 Treatment Options
 Conservative Therapy * (Severe restrictions, dietary,
fluids maintain renal function as long as possible- if GFR >
10ml/min)
 Hemodialysis
 Peritoneal Dialysis
 Transplant
 Nothing > Death

34
Conservative Treatment Goals
 Detect/treat potentially reversible causes of
renal failure
 Preserve existing renal function
 Treat manifestations
 Prevent complications
 Provide for comfort

35
 Conservative Treatment
 Control
 Hyperkalemia
 Hypertension

 Hyperphosphatemia

 Hyperparthryoidism

 Anemia

 Hyperglycemia

 Dyslipidemia

 Hypothyroidism
Depends on lab values-usually low
 Nutrition : Describe a renal diet?NA, K, restricted protein,
phosphorous, & fluids (See text)
36
 Hemodialysis
 Removal of soluble substances and water from the blood by
diffusion through a semi-permeable membrane.

 Early animal experiments began 1913

 1st human dialysis 1940’s by Dutch physician Willem Kolff (2
of 17 patients survived)
 Considered experimental through 1950’s, No intermittent
blood access; for acute renal failure only.
 1960 Dr. Scribner developed Scribner Shunt-1960’s machines
expensive, scarce, no funding.
 “Death Panels” panels within community decided who got to
dialyze.

37
 Hemodialysis Process
 Blood removed from patient into
extracorporeal circuit.
 Diffusion and ultrafiltration take place in
dialyzer.

 Cleaned blood returned to patient.

38
Extracorporeal Circuit

39
How Hemodialysis Works

40
 .
How Dialysis Works-Interactive!
An Introduction to Dialysis-How
Stuff Works! (Step by Step)
YouTube- Hemodialysis! Great!

                                                                            

                                                                            
 Vascular Access (click)
 Arterio-venous shunt (External Shunt) *used
now for Continuous Renal Replacement
Therapy (CRRT)-temporary access
 Arterio-venous (AV) Fistula (AKA-native or primary
fistula)
 PTFE Graft
 Temporary catheters
 “Permanent” catheters

42
 External Shunt (Schribner Shunt)
 External- one end into
artery, one into vein.
 Advantages
 place at bedside
 use immediately
 Disadvantages
 infection
 skin erosion
 accidental separation
 limits use of extremity
 *Used now only for
CRRT-temporary

43
 Arterio-venous (AV) Fistula
Primary (native) Fistula
 Patients own artery and vein surgically anastomosed.
 Advantages
 patient’s own vein/artery

 longevity

 low infection and thrombosis rates

 Disadvantages
 long time to mature, 1- 6 months

 “steal” syndrome

 requires needle sticks davita.com

44
PTFE (Polytetraflourethylene) Graft
 Synthetic “vessel” anastomosed into an artery and vein.
 Advantages
 for people with inadequate vessels

 can be used in 1-4 weeks

 prominent vessels

 Disadvantages
 clots easily

 “steal” syndrome more frequent

 requires needle sticks

 infection may necessitate removal of graft

45
 Temporary Catheters
 Dual lumen catheter placed into a central vein-
subclavian, jugular or femoral.
 Advantages
 immediate use

 no needle sticks

 Disadvantages
 high incidence of infection

 subclavian vein stenosis

 poor flow-inadequate dialysis

 clotting

 Restricts movement
46
 Cuffed Tunneled Catheters (Dacron cuff)
 Dual lumen catheter with Dacron cuff
surgically tunneled into subclavian,
jugular or femoral vein.
 Advantages
 immediate use; *permanent/long
term use
 can be used for patients that can have
No other permanent access
 no needle sticks
 Disadvantages
 high incidence of infection
 poor flows result in inadequate
dialysis
 clotting

47
 Above Native fistula (in place for over 20 “Temporary” vascular access catheters- if tunnelled,
years) with Dacron cuff, can be used long-term as
Permacath, below.
*Remember- assess circulation-listen for bruit,
feel for thrill!

Buttonhole technique-individual cannulates

own fistula
for home dialysis YouTube video
 Care of Vascular Access
 NO BP’s, needle sticks to arm with vascular
access. This includes finger sticks.
 Place ID bands on other arm whenever
possible.
 Palpate thrill and listen for bruit.
 Teach patient nothing constrictive, feel for
thrill.

49
 Potential
Complications of Hemodialysis
 During dialysis
 Fluid and electrolyte related
 hypotension
 Cardiovascular
 arrhythmias
 Associated with the extracorporeal circuit
 exsanguination
 Neurologic
 Disequilibrium Syndrome & seizures
 Musculoskeletal
 cramping
 Other
 fever & sepsis
 blood born diseases

50
Potential Complications of Hemodialysis
Long term (due to disease process
& management)
 Between treatments
•
 Hypertension/HypotensionMetabolic
 Edema
•Hyperparathyroidism
 Pulmonary edema
•Diabetic complications
 Hyperkalemia
•Cardiovascular
 Bleeding
CHF
 Clotting of access
AV access failure
Cardiovascular
disease
•Respiratory
Pulmonary edema
•Neuromuscular
51
Complications Hemodialysis- con’t-long term, ESRD

 Long term cont’d Long term cont’d

•Genitourinary
 Hematologic •infection
 anemia •Sexual dysfunction
 GI •Psychiatric
•depression
 bleeding
•Infection
 dermatologic •blood borne
 calcium pathogens
phosphorous
deposits
 Rheumatologic
 amyloid deposits
52
 Dietary Restrictions-Hemodialysis

 Fluid restrictions Urine output + 500-600

 Phosphorous restrictions Approx 800-1200 mg/day
 Potassium restrictions Approx 1-2 g/day; 40 mg/kg/IBW
 Sodium restrictions Approx 1-2 g/day
 Protein to maintain nitrogen balance (complete)
 too high - waste products
 too low - decreased albumin, increased mortality

 Calories to maintain or reach ideal weight

53
 Peritoneal Dialysis
 Removal of soluble substances and water from blood by diffusion through a
semi-permeable membrane (peritoneum) that is intracorporeal (inside
body).
 Solution warmed to body temperature prior to instillation into
peritoneal cavity via peritoneal catheter
 Metabolic waste products and excessive electrolytes diffuse into
dialysate while it remains in abdomen
 Fluid removal controlled by glucose (dextrose) concentration in
dialysate (acts as “osmotic” agent)
 Excess fluid/solutes removed- gradual/constant-
 Fluid drained by gravity into sterile bag at set intervals-
1. “Clear” solution ‘fills” abdomen
2. “Yellow” urine-like fluid drains out (like urine, clear)
3. Types of Peritoneal Dialysis
1. *CAPD: Continuous ambulatory peritoneal dialysis
2. CCPD: Continuous cycling peritoneal dialysis/Aka. *APD – Automated
Peritoneal Dialysis
3. IPD: Intermittent peritoneal dialysis (also)
54
 Phases of Peritoneal
Dialysis Exchange

1. Fill (inflow): fluid infused into

peritoneal cavity (usually 10-15
min).

2. Dwell time (equilibrium):

time solution (dialysate) fluid
remains in peritoneal cavity
(duration depends on method- as
CAPD 4-5 exchanges/day).

3. Drain (equilibrium): time

fluid drains from peritoneal cavity CAPD
by gravity flow (usually 20-30
min); facilitate by gently
massaging abdomen, changing
position.

55
 CAPD APD
 Catheter into peritoneal cavity  Automated Peritoneal
 Exchanges 4 - 5 times per day Dialysis- fluid exchanges
 Treatment 24 hrs; 7 days a week automatically by machine-
 Solution remains in peritoneal cavity (also known as continuous
except during drain time cycling peritoneal dialysis
 Independent treatment (CCPD), requires “cycler
machine”- programmable- to
automate filling and draining
process.
 Treatment at home, typically at
night (while sleeping-thus no
fluid in “the belly” at daytime

Click to play animation

Videos-Dialysis, all types!

Click to locate desired
 Complications of Peritoneal Dialysis
 Infection
 peritonitis  Obesity
 tunnel infections  Hypokalemia
 catheter exit site  Hernia
 Hypervolemia  Cuff erosion
 hypertension  Low back pain
 pulmonary edema  Hyperlipidemia
 Hypovolemia
 hypotension
 Hyperglycemia
 Malnutrition
Peritoneal Catheter Exit Site

58
 Advantages of PD
 Independence for patient
 No needle sticks
 Better blood pressure control
 Some diabetics add insulin to solution
 Fewer dietary restrictions
 protein loses in dialysate
 generally need increased potassium

 less fluid restrictions

59
Multi-prong system
occasionally used
with PD patients in
hospital settings
Which dialysis
“bags” have
already been
infused?

The “yellow”
ones!- dialysis
nurse sets up
bags, staff nurse
infuses, drains
according to
schedule.

60
Medications - Dialysis Patients & CKD (Stages 4-5)

 Vitamins - water soluble

 Phosphate binder - (Phoslo, Renagel, Calcium,
*Aluminum hydroxide-risks) Give with meals
 Iron - don’t give with phosphate binder or calcium
 Antihypertensives – typically hold prior to dialysis
 Erythropoietin
 Calcium Supplements - Between meals, not with iron
 Activated Vitamin D3 - aids in calcium absorption
 Antibiotics - hold dose prior to dialysis if it dialyzes out

62
 Medications
 Many drugs or their metabolites are
excreted by the kidney
 Dosages - many change when used in
renal failure patients
 Dialyzability - many removed by dialysis
varies between HD and PD

63
 Patient
Education
 Alleviate fear
 Dialysis process
 Fistula/catheter care
 Diet and fluid restrictions
 Medication
 Diabetic teaching

64
 Case Study
A 48 year old female with a history of uncontrolled
diabetes presents to the ER. Her chief complaints are
nausea, vomiting and fatigue.
Lab: BUN 100; Creatinine 10; H&H 7.0/21.4;
K+ 6.0, PO4 5.5; Ca++ 7.5

What do you suspect? How would she possibly be treated?

*Access Evolve Apply Case Study- Chronic Renal Failure

*Access Renal Case Study

65
 Transplantation

 Treatment not cure

View also Organ Donation video

66
Kidney Awaiting Transplant

67
“Old” kidneys typically left in place

68
 Advantages Disadvantages
 Restoration of “normal”  Life long medications
renal function  Multiple side effects
 Freedom from dialysis from medication
 Return to “normal” life  Increased risk of tumor
 Reverses  Increased risk infection
pathophysiological  Major surgery
changes related to RF
 Less expensive than
dialysis after 1st year
 Care of Recipient
 Major surgery with general anesthesia
 Assessment of renal function
 Assessment of fluid and electrolyte
balance
 Prevention of infection
 Prevention and management of rejection

70
 Post-op Care
 ATN? (acute tubular necrosis)
 50% experience
 Urine output >100 <500 cc/hr
 BUN, creatinine, creatinine clearance
 Fluid Balance-careful monitor
 Ultrasound
 Renal scans
 Renal biopsy
71
 Fluid & Electrolyte Balance
 Accurate I & O
 CRITICAL TO AVOID DEHYDRATION

 Output normal - >100 <500 cc/hr, could be 1-2

L/hr
 Potential for volume overload/deficit

 Daily weights
 Hyper/Hypokalemia potential
 Hyponatremia
 Hyperglycemia

72
 Prevention of Infection

 Major complication of transplantation due to

immunosuppression
 HANDWASHING
 Avoid Crowds, Kids
 Patient Education

73
 Rejection
 Hyperacute - preformed antibodies to donor antigen
 function ceases within 24 hours
 Rx = removal
 Accelerated - same as hyperacute but slower, 1st week to month
 Rx = removal
 Acute - generally after 1st 10 days to end of 2nd month
 50% experience
 must differentiate between rejection and cyclosporine toxicity
 Rx = steroids, monoclonal (OKT 3), or polyclonal (HTG)
antibodies
 Chronic - gradual process of graft dysfunction
 Repeat rejection episodes- not completely resolved with
treatment
 4 months to years after transplant
 Rx = return to dialysis or re-transplantation
74
 Immunosuppressant Drugs
 Cytoxic Agents-Azathioprine
 Corticosteroids-Prednisone (Imuran); Mycophenolate
 Prevents infiltration of T (*Cellcept), *Cytoxin (less
lymphocytes toxic than Imuran)
 Prevents rapid growing
 Side effects lymphocytes
 cushingoid changes
 Side Effects
 Avascular Necrosis  bone marrow toxicity
 GI disturbances  hepatotoxicity

 Diabetes  hair loss

 infection  infection

 risk of tumor
 risk of tumor
 Immunosuppressant Drugs

 Calcineuin Inhibitors-
 Monoclonal antibody-
OKT3 - used to treat
Cyclosporin, Neoral, rejection/induce
*Prograft, *FK506 (more immunosuppression
potent than cyclosporin)  decreases CD3 cells within
 Interferes with production of 1 hour
interleukin 2 which is necessary  Side effects
for growth and activation of T
 anaphylaxis
lymphocytes.
 Side Effects  fever/chills
– Nephrotoxicity  pulmonary edema
– HTN
 risk of infection
– Hepatotoxicity
 tumors
– Gingival hyperplasia

– Infection
 1st dose reaction expected
& wanted, pre-treat with
Benadryl, Tylenol, Solumedrol
 Immunosuppressant Drugs cont’d
 Polyclonal antibody-Atgam-treat rejection or induce
immunosuppression
 decreased number of T lymphocytes

 Side effects
 anaphylaxis

 fever chills

 leukopenia

 thrombocytopenia

 risk of infection

 tumor

77
 Patient Education
 Signs of infection
 Prevention of infection
 Signs of rejection
 decreased urine output
 increased weight gain
 tenderness over kidney
 fever > 100 degrees F
 Medications
 time, dose, side effects

78
 Transplants
Notes from Organ Donation slides

 Exclusion for Transplant not limited too

 Active vasculitis; or
 Life threatening extrarenal congenital abnormalities;
or
 Untreated coagulation disorder; or

 Ongoing alcohol or drug abuse; or

 Age over 70 years with severe co-morbidities; or

 Severe neurological or mental impairment, in persons

without adequate social support, such that the person
is unable to adhere to the regimen necessary to
preserve the transplant.

79
 Official Criteria for Deceased
Donors
 Usually irreversible brain injury
Usually irreversible brain injury
 MVA, gunshot wounds, hemorrhage, anoxic brain injury from
MI
 Must have effective cardiac function
 Must be supported by ventilator to preserve organs
 Age 2-70
 No IV drug use, HTN, DM, Malignancies, Sepsis, disease
 Permission from legal next of kin & pronoucement of death made
by MD
 *Brain Death is the complete cessation of all brain &
brainstem function. It is death.

80
Official Criteria for Living Donors
 Psychiatric evaluation
 Anesthesia evaluation
 Medical Evaluation
 Free from diseases listed under deceased donor
criteria
 Kidney function evaluated
 Crossmatches done at time of evaluation and 1
week prior to procedure
 Radiological evaluation
 Nurses Role in Event of
Potential Donation
 Notify TOSA of possible organ donation
 Identify possible donors
 Make referral in timely manner

 Do not discuss organ donation with family

 Offer support to families after referral is
made & donation coordinator has met with
family

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