NORCET 2 -2021 (Shift…: A person agrees with the organ donation .Before transplantation which thing should be done as priority?

NORCET 2 -2021 (Shift-2)

Medical & Surgical Nursing

Medium

Appeared in: NORCET 2 -2021 (Shift-2)

Explanation

Biochemical cross-matching is the highest priority pre-transplant test to prevent hyperacute rejection.
This test detects pre-formed donor-specific antibodies in the recipient's serum which, if present, would cause an immediate and irreversible attack on the new organ.
A positive cross-match (where recipient antibodies react to donor cells) is an absolute immunologic contraindication for transplantation, making this test the final and most critical checkpoint.

Option A: While obtaining consent is a critical ethical and legal step, if the donor has already legally consented (e.g., via a donor card or registry), the family's consent may not be the absolute priority, especially compared to urgent medical compatibility testing. Medical viability takes precedence at the point of surgery.
Option B: Blood type (ABO) compatibility is a fundamental and early step in the matching process. It is essential, but it is a broader, less specific test than cross-matching. A compatible blood type does not guarantee that the recipient lacks other, more specific antibodies against the donor's tissues.
Option D: Screening for viral markers like HIV and hepatitis is crucial for the long-term safety of the recipient to prevent disease transmission. However, it does not address the immediate, minute-by-minute threat of hyperacute organ rejection, which is the focus of cross-matching.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Prioritization of pre-transplantation procedures in the correct sequence, documenting the action clearly, and monitoring for the expected response.
A nurse's role in organ transplantation is multifaceted, including coordinating tests, ensuring results are available, and preparing the patient. Understanding that a positive cross-match is an absolute contraindication is vital for patient communication and managing expectations.
A positive cross-match means the transplant is cancelled. The nurse must then provide emotional support to the recipient and their family, who have likely been preparing for a life-changing surgery, and explain the medical reasoning in understandable terms.
What if? If the transplant was for an identical twin, the need for immunosuppression and the risk of rejection are virtually zero. In this rare case, while still performed for safety, the cross-match would be a formality, and the priority might shift to ensuring the donor's surgical and psychological readiness.

How to Approach the Question

First, identify the core of the question: it asks for the 'priority' action immediately before transplantation.
Analyze the options in terms of urgency and immediate consequence. All options are important procedures in the overall transplant process.
Consider the most immediate, life-threatening (for the organ) complication. Hyperacute rejection destroys the organ within minutes to hours.
Evaluate which test directly prevents this immediate complication. Blood typing is a start, but biochemical cross-matching is the specific test for pre-formed antibodies that cause hyperacute rejection.
Differentiate between essential safety checks (like viral markers) and immediate immunological compatibility checks (cross-matching). The immunological check is the highest priority at the moment of transplant.
Therefore, conclude that biochemical cross-matching is the most critical priority action right before the surgery commences.

Concept Tested & Keywords

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E6 Medicine Harrison 22e Part 2 p. 310-312

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