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.. y. Nurses need to assess: (a) psychosocial needs, (b) functional outcomes, (c) quality of life, (d) daily living, (e) psychiatric outcome, and (f) financial needs. The nurse must use skills in crisis intervention to help ease the disequilibrium of the family. Nurses need to be sensitive to patient and family needs.

Nurses must help the patients and their families to cope with(a) disease chronicity, (b) waiting period, (c) role reversal, (d) hospitalization, and (e) complicated medical regimen as well as take into consideration the demands on(a) time, (b) energy, (c) finances, and (d) relationships that the disease has placed on patients and their families. The burdens and challenges that this crisis places on patients and their families are many. These can also include(a) the uncertantity of rejection, (b) the uncertantity of future health and well-being, (c) social isolation, (d) financial burdens, (e) possible organ failure, (f) increased risk of two family members undergoing surgery, and (g) feelings of guilt from non-donating persons or family members (Ganley, P. P., 1995). As transplant moves into the critical care setting, nurses are going to have to be prepared for optimal management of donors, canidates, and recipients. They need to optimize patient outcomes through extended knowledge bases and education about:: (a) the procedure, (b) the human immune response, (c) the pharmacology of immunosuppression, and (d) physiological and psychologic and behavior responses to transplantation (Smith, S.

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L., 1993). Nurses need to continue to be patient advocates. We need to encourage communication, allow families to ventilate anger, fear, and guilt and to educate patients and families about what to expect. Nurses need to remember when designing care paths and nursing diagnosis that it is important to include the necessary ones related to the patients condition such as, potential for infection related to interrupted skin integrity, which is the nursing diagnosis that the current nursing research is focused on; but we also need to include nursing diagnoses that focus on the patient and family as a whole. A key nursing diagnosis would be anxiety secondary to knowledge deficit about liver donation/transplantation.

We need to educate patients and their families and take the time to answer their questions and listen to their fears and concerns. All too often nurses get caught up in the machines that are taking care of the patient’s condition but we must remember that there is no machine that can care for the patient and family, only the human response and caring of a nurse can preserve the “person”. There are still many ethical issues that surround living donor organ transplantation. Issues that arise include(a) risks versus benefits, (b) selection of donor and recipient, and (c) informed consent. The largest risks to recipients include(a) organ rejection, (b) organ failure, and (c) possible death.

Benefits to recipients include a normal life or closer to normal life. Risks to donors include(a) partial hepatectomy, (b) complications, and (c) possible death. Benefits to donors include psychological benefits and the degree depends upon the relationship between donor and recipient (Singer, P. A. et.

al., 1989). Arguments for living donor organ transplantation include(a) reduction of pre- transplant mortality, (b) provides a new source of livers for transplantation, (c) allows the transplant to be performed before the recipient’s condition deteriorates from complications, (d) immunologic advantage, and (e) fulfills powerful motivation of parent/other to participate (Lynch, S. V., Strong, R. W., & Ong, T. H., 1992).

Arguments against living donor organ transplantation include(a) may be uneccessary, (b) frequently require retransplant from cadaver source, and (c) poses unknown risk to donor (Lynch, S. V., et. al., 1992). But most medical decisions are based on the question of whether or not the risks outweigh the benefits and in the case of living donor organ transplantation, the decision should be made on an individual basis but keep in mind that, “..when a donor is genetically and emotionally related to the recipient, the intangible benefits of saving a life are most rewarding, and the risk-benefit ratio is most favorable” (Singer, P. A., et.

al., 1989, p. 621). Although the procedure of living donor organ transplantation is truly a controversial issue, the nursing care of these patients and their families has not been well documented. The medical documentation and research on the actual procedure has been minimal and the little nursing research that is out there is out-dated and incomplete. Because of the specialty of transplantation and the uniqueness of the procedure there is a need for more research and detailed information in order for all nurses and health care providers to provide optimal care to patients and their families who are experiencing living donor organ transplantation.

Since living donor organ transplantation will probably become a more common procedure, research and knowledge related to the topic will help nurses better function in their role as caregiver and patient advocate. Therefore we need to continue searching for the answers and better ways to optimize patient outcomes. Although I have not experienced this clinical concept in my nursing practice, I am currently experiencing it in my personal life. I have found that it is sometimes complicated to separate one’s nursing skills and behaviors from one’s personal feelings. I was disappointed in my search for information related to living donor organ transplantation.

It is also disheartening that nurses in this field have not tried to educate their fellow nursing professionals in this area of study. Bibliography Broelsch, C. E., Burdelski, M., Rogiers, X., Gundlach, M., Knoefel, W. T., Langwieler, T., Fischer, L., Latta, A., Hellwege, H., Schulte, F., Schmiegel, W., Sterneck, M., Greten, H., Kuechler, T., Krupski, G., Loeliger, C., Kuehnl, P., Pothmann, W., & Schulte Am Esch, J. (1994).

Living donor for liver transplantation. Hepatology, 20 (1), 495-555. Ganley, P. P. (1995).

Living related liver transplantation (LRLT) in childrenFocus on issues. Pediatric Nursing, 21 (6), 523-525. Heffron, T. G. (1993). Living-Related pediatric liver transplantation.

Seminars in Pediatric Surgery, 2 (4), 248-253. Jones, J., Payne, W. D., & Matas, A. J. (1993).

The living donors- Risks, benefits, and related concerns. Transplantation Reviews, 7 (3), 115-128. Lynch, S. V., Strong, R. W., & Ong, T. H.

(1992). Reduced-size liver transplantation in children. Transplantation Reviews, 6 (89), 115-128. Singer, P. A., Siegler, M., Whitington, P.

F., Lantos, J. D., Emond, J. C., Thistlewaite, J. R., & Broelsch, C. E. (1989). Ethics of liver transplantation with living donors.

The New England Journal of Medicine, 321 (9), 620-621. Smith, S. L. . (1993). The cutting edge in organ transplantation. Critical Care Nurse, supp.

June, 10-30. Wise, B. V. . (1994). Advances in pediatric solid organ transplantation.

Nursing Clinics of North America, 29 (4), 615-629.

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