Intestinal Transplantation in Pediatric Patients: A Nursing Challenge: Part One: Evaluation for Intestinal Transplantation

Abstract

Intestinal transplantation offers hope to children with intestinal failure and life-threatening complications of parenteral nutrition (PN). As more transplant centers are adding intestinal transplantation to their existing programs, new challenges are presented to nursing professionals. This three-part series will provide information for nursing professionals regarding evaluation for intestinal transplantation, donor preparation, the surgical procedure, immediate postoperative care of the transplant recipient, complications of intestinal transplantation, and long-term care of the intestinal transplant patient. Part 1 will discuss the indications for intestinal transplantation, the evaluation of patients for intestinal transplantation, the process of listing patients for intestinal transplantation, and the waiting time for donor organs for intestinal transplantation. The information presented represents the approach taken at University of Nebraska Medical Center.

Intestinal Transplantation: The Evaluation Process

“…A patient question and answer session is included at this time. 1,6 Upon completion of the entrance interview, the candidate will begin the diagnostic and consultation period of the evaluation. In our experience, candidates report feelings of overwhelming anxiety, fatigue, and fear of evaluation outcomes during the testing phase.…”

“…The goal of the evaluation is to determine both the patient's need for transplantation as well as an appropriate therapy. 6 Appropriate therapy may be defined as gut rehabilitation, recommendation of longterm total parenteral nutrition (TPN), or 1 of 3 transplant options: isolated intestine, combined liver/bowel, or multivisceral organ transplantation. The components of the evaluation must reveal the patient's degree of intestinal failure, associated organ dysfunction, available support system, financial capability, educational needs, and potential for lifetime management compliance.…”

“…An interdisciplinary and patient-specific approach is essential to assess appropriate candidacy and to determine therapeutic options. 1,5,6 The purpose of this article is to present a detailed definition and analysis of the evaluation process, including the UNOS listing criteria. The evaluation needs of adult and pediatric patients will be addressed, highlighting differences when necessary.…”

Clinical practice guidelines—Nursing management for pediatric patients with small bowel or multivisceral transplant

“…In the preoperative stage, in order for a patient to be listed for transplant, a complete work‐up must be performed. Laboratory values necessary for placement on the transplant list vary slightly depending on insurance coverage and transplant center (Andersen et al., a). Additionally, before the decision to list for transplant is made, the transplant team must assess the caregiver's demonstrated ability to learn postoperative care and techniques, as well as ensuring that caregivers will be available within a previously determined arrival time to the hospital (Kocoshis et al., ).…”

“…Prior to this, patients with intestinal failure were maintained on parenteral nutrition with no other options for medical management. This condition led to the first successful intestinal transplant in 1987, although all transplants prior to 2001 have been considered experimental (Andersen, DeVoll‐Zabrocki, Brown, Iverson, & Larsen, a; Hauser, Kaufman, Matsumoto, & Fishbein, ). Because this procedure is relatively new, there is limited published research.…”