Perfusion Machine Impact on Liver Transplantation: Strategies & Care
HPE1005 - Mental Health Issues
University of Cincinnati
Perfusion Machine for Restoring Donor Livers for Transplant
Introduction
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
Liver transplantation, particularly among liver-related diseases, especially the end-stage, is the
only defined cure to prevent morbidity and death. Over a quarter of the global population has
been affected by fatty liver disease, classified as the most prevalent chronic condition and
disease of the liver. Previously specialized preservation solutions were used to preserve the
modality of the liver before transplanting. Despite its success over the last thirty years, there
have been several global demands concerning liver transplantation that have reduced the
availability of suitable liver organs. To combat this issue, new strategies were developed to
expand the donor pool for livers, including donations after Brain (DBD), extended criteria
donor (ECD), and circulatory death (Detelich et al., 2018). However, these strategies have led
to complications such as early allograft dysfunction, increased susceptibility towards
ischemiareperfusion injury, and higher risks of primary nonfunction.
The specialized preservation solutions that implemented static cold storage as a means of
preserving the donor's livers seemed ineffective with the new strategies of preserving liver
donors as ECD requires specific preservation conditions with the need for oxygen circulation
s compared to specialized preservation solutions, which reduces metabolic activity thus leading
to toxic metabolites accumulation and mitochondrial metabolism. Machine perfusion (MP) is
a recently introduced technology in the healthcare industry. It has proved to be effective in
successful liver transplants obtained from DCD, circulatory death, and ECD donations due to
its decreased prevalence of complications after liver transplant (Vilz et al., 2021). Furthermore,
with the implementation of MP in hospital settings, nurses must be provided with knowledge
and training on its use to facilitate better patient outcomes. A patient that underwent a liver
transplant with a donor liver obtained from machine perfusion is less likely to have
symptomatic nonanastomotic biliary strictures than a patient that used specialized preservation
solutions if the liver was obtained from ECD.
Background
Machine perfusion is an instrument that facilitates the preservation of liver organs
obtained from ECD, DBD, and circulatory death, which are to be transplanted. This machine
ensures that the liver organ is kept under the optimum temperature, which can either be cold or
warm. Machine perfusion acts as a platform to allow the liver to live outside the body while
facilitating repair and regeneration. The classification of the machine perfusion is based on
temperature, which temperatures between 35-38 0c as normothermic, 20-30 0c as sub
normothermic, and 4-10 0c as hypothermic. Normothermic machine perfusion aims to maintain
optimum metabolic function while avoiding cold ischemic injury, and sub-normothermic
machine perfusion acts as a compromise between cold and warm perfusion (Detelich et al.,
2018). On the other hand, hypothermic machine perfusion aims to restore mitochondrial
function while reducing the release of reactive oxygen species (ROS).
In the case of normothermic machine perfusion, the machine keeps the organs warm by
pumping blood through them, and this is referred to as ex vivo organ perfusion, which allows
the organ to stay longer outside a human body’s, thus decreasing the urgent time needed for the
transplant. The blood is pumped directly from the vena cava through a single centrifugal pump
which passes through an oxygenator. The perfusate or the blood then passes through a circuit
toward the soft-shell reservoir for the portal vein and the hepatic artery perfusion. During this
process, the perfusion, rate, and temperature pressure are measured and controlled (Simone et
al.,
2022). Machine perfusion is mainly used for patients with end-of-stage liver disease; liver
transplantation is the only cure they need to survive. According to Webb et al. (2022), machine
perfusion, despite its high costs of usage and pay among patients, was discovered to be more
cost-effective as compared to SCS. The mean cost of liver transplantation using machine
perfusion was estimated at $456,455 compared to SCS, which was 519,222. This is because
the use of machine perfusion showed fewer complications after the transplant, which reduced
the total costs of hospital fees compared to the use of the SCS, which resulted in complications
leading to more hospital fees. Similarly, the use of machine perfusion leads to a decreased use
of other forms of medicine among patients, such as chemotherapy.
Risks and Benefits
Machine perfusion increases patient outcomes through the liver transplantation process,
thus enabling them to live for a longer time. It also allows the repair and regeneration of donor
livers obtained from ECD and DBD and the ability to test for liver functionality before the
transplantation procedure occurs, thus enabling patients to acquire competent functioning
livers after the transplant (Detelich et al., 2018). In addition, machine perfusion reduces the
risks of ischemia injuries after the liver transplant. Patients with the end of stage liver disease
can easily acquire liver transplants due to an increased donor pool, thus reducing the morbidity
and deaths caused by liver conditions. Positive outcomes are generally improved through the
use of normothermic machine perfusion, which minimizes the development of ischemia injury
leading to graft loss or damage of the donor's liver.
Complications that May Arise
Complications that may arise with machine perfusion include irreparable and irreversible
damage to the graft used for liver transplantation. Device malfunction, technical problems, and
human inexperience and errors are all complications that may arise from machine perfusion
use (Simone et al., 2022). In addition, organs under normothermic conditions are bound to
develop warm ischemia leading to graft loss.
Considerations for Preventing Complications
To decrease graft loss through ischemia injury, the MP can be used to enhance the
mitochondrial function, reducing the reactive oxygen species production and the inflammation
experienced during reperfusion (Boteon et al., 2019). Another consideration to prevent
complications is to provide competent training to personnel involved in the use of the Machine
perfusion to avoid any errors which may lead to graft loss.
Interdisciplinary Team’s Roles and Responsibilities
Various healthcare professionals are involved in the care of patients with end-stage liver
disease and scheduled for liver transplants. These professionals work together to improve and
enhance patient outcomes through individualized care. The interdisciplinary team members
include hepatologists, physicians, clinical desk assistants, transplantation surgeons, social
workers, transplant nurse coordinators, dietarians, radiologists, and anesthesiologists.
Hepatologists are doctors that specialize in liver diseases and the management of liver failure
before the transplantation procedure. Physicians deal with infection treatments related to liver
disease. The clinical desk assistant handles all the administration affairs associated with the
patient, while the transplantation surgeon handles the surgery for the liver transplant. Social
workers and dietarians, guide and assist the family and the patient with the care and practices
needed before and after the transplant.
Furthermore, the radiologists treat liver tumors before the transplantation procedure occurs,
and the anesthesiologists administer sedatives and anesthetics during the liver operation and
provide care to the patients in the intensive care unit. However,, in the use of the machine
perfusion, transplant surgeons are the main healthcare professionals involved in its use.
Perfusionists are also personnel involved in the use of machine perfusion, and their main role
is operating the machine involved in the preservation of donor's livers. They also monitor the
patient during the surgery process and ensure that all the equipment used in the machine
perfusion is functioning appropriately. Nurses play a pivotal role in the management of and
provision of care to patients with end-of-stage liver disease (Masih et al., 2019). Nurses identify
grant dysfunction, and infection and are critical in the rejection of the grant due to the lengthy
time spent with the patient at their bedside. They also provide medication and social assistance
and provide them with education regarding the surgical procedure. The nurses also conduct an
assessment to determine whether the patient's physical condition is appropriate for the medical
condition (Masih et al., 2019). The nurses also check for the circulation and breathing patterns
of the patient before the surgery occurs.
Nursing Scope of Practice
Registered nurses need the knowledge, skills, and attitudes to provide care for patients
using machine perfusion. Nurses must have competent knowledge of the use of the machine
perfusion application and use. Nurses must also possess knowledge of the post and pre-
operative care to be provided to patients to enable positive health outcomes. In addition, nurses
need assessment skills crucial in the pre-operative phase, such as conducting X-rays, computed
tomography, and monitoring of urine and blood culture. In addition, the nurses require
knowledge of mechanical ventilator use, arterial cannual, nasogastric tube, and monitoring of
vital signs (Youssef et al., 2022). The nurse is also required to have competent skills in patient
education. Nurses must be able to provide education regarding the patient's treatment and
medical procedures before the patient undergoes surgery. Nurses need effective administrative
skills for managing and providing care for the family before and after the surgical treatment
and procedure. In addition, nurses require the necessary knowledge to identify the dysfunction
in the grant, any infections, and rejection (Youssef et al., 2022). Nurses require attention to
detail, patient assessment, critical thinking, urgent care, effective communication skills,, and
physical endurance. Such skills are vital to discovering infections and rejections which may
occur after the liver transplant operation. The attitudes needed for registered nurses include
empathy which is used in conveying education and information to the patients and their
families regarding the surgical procedure, treatment, and nutritional practices while reducing
their anxiety and stressors linked with the occurrence of the surgical procedure.
Patient Education
Nurses play a pivotal role in the education of patients and families concerning the surgical
procedure involved at the end of stage liver disease. Nurses are required to provide competent
education to patients in relation to the liver transplant surgical procedure and the selfcare
processes needed to ensure positive outcomes for the patient. The patient will be taught the
family involves the types of equipment used for treatment procedures, the strategies to improve
quality of life, home-based care and initiatives, medication and schedule, side effects of the
medication, other medications to use, and the daily routines to promote a better quality of life
(Heath, 2021). The patient information will be taught through educational material preferred
by the patients, such as posters, graphics, brochures, demonstrations, and one on one teaching.
Some of the potential cultural considerations concerning teaching patients include the use of
easy and simple language. The nurse must ensure that they convey the teachings and
information in relation to the patient’s language preference in simple easy to understand
dialogue. If the patient does not understand English, the nurse should utilize language
interpreters and charts to convey the teaching to the patient. In addition, while teaching the
patient, the educator must consider the patient’s customs, beliefs, traditions, and
communication methods. To evaluate the teaching effectiveness, the nurse or educator can
utilize the use of the teach-back strategy on the patient (Heath, 2021). This strategy involves
teaching a patient a particular concept or aspect of a given procedure and then requiring the
patient to respond to the educator about the concept in their own words. This strategy is
effective in determining whether the patient has successfully comprehended the information
communicated to them. If not, the educator or clinician can implement other techniques to
ensure the patient fully understands the concept.
Conclusion
The development of perfusion machines used in donor liver preservation before liver
transplant procedure has greatly improved the donor base of livers as they can now be obtained
through circulatory death, ECD, and DBD, thus improving the likelihood of survival of end-
ofstage liver disease caused by the shortage of liver donations globally. Machine perfusion
helps in reducing the presence of complications that arise from liver transplants, such as
ischemia damage which leads to grant loss. The perfusion machine also helps in the repair and
regeneration of the donor's liver before transplantation. It reduces the urgency of
transplantation surgery by providing conditions to enable the preservation of the liver organ
outside of the human body. Healthcare professionals need to work together hand in hand to
provide optimum care to patients involved in liver transplantation, and nurses are essential in
providing quality care to patients. They are also required to provide patients with competent
education concerning the disease, treatments, and home-based practices to improve the quality
of care.
References
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