Organ Transplant Case Study
J.L., a 35-year-old-male, was found “down” at home for an unknown reason. Upon
hospitalization he was diagnosed with a subarachnoid hemorrhage from
a ruptured cerebral aneurysm. J.L. is in grave condition with a poor prognosis.
The nurse takes the first step for organ donation by calling the regional Donor Network
to notify them of J. L.’s low Glasgow Coma Scale score and current condition.
J.L. is later determined to be brain dead by means of a clinical neurological exam, apnea
test, and cerebral blood flow study. He was an organ donor per his wishes, and the
organ procurement team is called to begin managing his case.
Discussion Questions:
1. What are some possible causes for J.L. to have prerenal failure in this
situation?
a. Pre-renal AKI occurs when something reduces systemic circulation,
which eventually can cause decreased renal blood flow. When there is
decreased renal blood flow, decreased glomerular perfusion and
filtration can eventually develop. In the case of J.L. there are several
potential causes of prerenal failure – which include decreased cardiac
output, hypovolemia, severe hypotension, and poor systemic perfusion.
He has a neurological injury, which means that he has decreased
peripheral vascular resistance. And he had been down on the ground
when he was found for an unknown amount of time – which could
contribute to prolonged hypotension/volume depletion. Both of which
could potentially contribute to reduced renal blood flow (Harding, M.,
Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2022), p. 1233).
2. Is there a possibility that J.L. could have intrarenal renal failure? Why or why
not?
a. Yes he could have intrarenal failure. If the prerenal failure continues for
too long, it could progress to intrarenal AKI since prolonged decreased
perfusion can lead to kidney tissue injury. The likely mechanism behind
this would be ischemic acute tubular necrosis (ATN). Prolonged
hypotension and hypovolemia could laso lead to an AKI (Harding, M.,
Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2022), p. 1233 - 1234).
3. What labs do you expect the organ procurement team to order to evaluate the
possibility of kidney injury?
a. Serum creatinine (0.6 – 1.2) and BUN (10 – 20), and GFR (90+) are the
best labs to assess when determining the possibility of a kidney injury.
, Excessively high creatinine and BUN levels, as well as decreased GFR
levels, are clear indicators of an AKI. However, creatinine is the best
serum indicator since it is not affected by other factors. Other tests
that would be beneficial for determining the presence of an AKI would
be a urinalysis, urine output assessment, and urine concentration
indices (Harding, M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C.
(2022), p. 1235)
NGN Style Question:
➢ For each potential intervention, specify whether the intervention is indicated or
not indicated (Each row must have 1 response selected) NO PAGE #s needed
here – use previous knowledge from AKI, shock, cardiac content, pharmacology
etc. (Adult I&II)
Potential Intervention Indicated Not Indicated
Hold Lovenox injections X
Infuse Lactated Ringers with 10 meq KCL at 100 mL/hr X
Administer Vasopressin prn to maintain BP >120 systolic X
Discontinue all corticosteroids X
Monitor GCS score and pupillary response X
Hourly urine output monitoring X
Part 2:
J.L. is medically managed, stabilized and his organs are harvested. A long-term renal
failure patient, T.Y. receives one of his kidneys.
Past Medical History:
• Hypertension
• Hypercholesterolemia
• Type 2 Diabetes (common in ESRD) (Harding, M., Kwong, J., Roberts, D., Hagler, D.,
& Reinisch, C. (2022), p. 1259 – 1260)
J.L., a 35-year-old-male, was found “down” at home for an unknown reason. Upon
hospitalization he was diagnosed with a subarachnoid hemorrhage from
a ruptured cerebral aneurysm. J.L. is in grave condition with a poor prognosis.
The nurse takes the first step for organ donation by calling the regional Donor Network
to notify them of J. L.’s low Glasgow Coma Scale score and current condition.
J.L. is later determined to be brain dead by means of a clinical neurological exam, apnea
test, and cerebral blood flow study. He was an organ donor per his wishes, and the
organ procurement team is called to begin managing his case.
Discussion Questions:
1. What are some possible causes for J.L. to have prerenal failure in this
situation?
a. Pre-renal AKI occurs when something reduces systemic circulation,
which eventually can cause decreased renal blood flow. When there is
decreased renal blood flow, decreased glomerular perfusion and
filtration can eventually develop. In the case of J.L. there are several
potential causes of prerenal failure – which include decreased cardiac
output, hypovolemia, severe hypotension, and poor systemic perfusion.
He has a neurological injury, which means that he has decreased
peripheral vascular resistance. And he had been down on the ground
when he was found for an unknown amount of time – which could
contribute to prolonged hypotension/volume depletion. Both of which
could potentially contribute to reduced renal blood flow (Harding, M.,
Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2022), p. 1233).
2. Is there a possibility that J.L. could have intrarenal renal failure? Why or why
not?
a. Yes he could have intrarenal failure. If the prerenal failure continues for
too long, it could progress to intrarenal AKI since prolonged decreased
perfusion can lead to kidney tissue injury. The likely mechanism behind
this would be ischemic acute tubular necrosis (ATN). Prolonged
hypotension and hypovolemia could laso lead to an AKI (Harding, M.,
Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2022), p. 1233 - 1234).
3. What labs do you expect the organ procurement team to order to evaluate the
possibility of kidney injury?
a. Serum creatinine (0.6 – 1.2) and BUN (10 – 20), and GFR (90+) are the
best labs to assess when determining the possibility of a kidney injury.
, Excessively high creatinine and BUN levels, as well as decreased GFR
levels, are clear indicators of an AKI. However, creatinine is the best
serum indicator since it is not affected by other factors. Other tests
that would be beneficial for determining the presence of an AKI would
be a urinalysis, urine output assessment, and urine concentration
indices (Harding, M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C.
(2022), p. 1235)
NGN Style Question:
➢ For each potential intervention, specify whether the intervention is indicated or
not indicated (Each row must have 1 response selected) NO PAGE #s needed
here – use previous knowledge from AKI, shock, cardiac content, pharmacology
etc. (Adult I&II)
Potential Intervention Indicated Not Indicated
Hold Lovenox injections X
Infuse Lactated Ringers with 10 meq KCL at 100 mL/hr X
Administer Vasopressin prn to maintain BP >120 systolic X
Discontinue all corticosteroids X
Monitor GCS score and pupillary response X
Hourly urine output monitoring X
Part 2:
J.L. is medically managed, stabilized and his organs are harvested. A long-term renal
failure patient, T.Y. receives one of his kidneys.
Past Medical History:
• Hypertension
• Hypercholesterolemia
• Type 2 Diabetes (common in ESRD) (Harding, M., Kwong, J., Roberts, D., Hagler, D.,
& Reinisch, C. (2022), p. 1259 – 1260)
