In many aspects, the early postoperative nursing care for both the recipient and donor in renal transplantation is similar to that of any other major surgical treatment (Hinkle & Cheever, 2014). The emphasis is mostly on maintaining physiological homeostasis through electrolyte and fluid balance. Wound treatment is also essential. The patient will also be given pain relievers. The RN should also use incentive spirometry to perform proper pulmonary toilet. Early ambulation and the restoration of normal bowel habits ought to be encouraged (Hinkle & Cheever, 2014). The donor’s gastrointestinal function is usually uncomplicated, while the recipients may be constipated due to the side effects of drugs such as phosphate binders and corticosteroids (Hinkle & Cheever, 2014). During the procedure, the retroperitoneal dissection can also result in postoperative constipation. The RN should then administer an enema, stool softeners or even bulk forming laxatives. The donor and recipient should both have a urinary catheter. This is important in the monitoring of urine output and therefore fluid and electrolyte balance (Hinkle & Cheever, 2014).
For both patients, the catheter is left in place longer to protect the suture line between the bladder and the ureter (Hinkle & Cheever, 2014). For the recipient, sutures are left for three weeks. Corticosteroid use in these patients is associated with slow healing. The recipient should, however, have a more comprehensive renal function assessment and should be monitored for early detection of complications. This care is critical in ensuring that transplantation complications including transplant rejection and graft versus host are adequately dealt with early enough (Hinkle & Cheever, 2014).
Just like in this case, living donations are becoming extremely common particularly when the donor is related to the recipient; this is due to increased demand. Living donation presents with the ethical dilemma of the potential risk to the healthy living donor (Wadhwa & Kayes, 2013). The premise of medicine is 'do no harm, ' and for this case, harm is done to an individual. For living related donors, coercion should be considered. This can be in any form including social, financial, familial, psychological or tribal. Coercion is not acceptable, and therefore before transplantation, the willingness of the donor should be assessed, through thorough psychological testing (Wadhwa & Kayes, 2013).
It is illegal to financially benefit from organ transplantation (Wadhwa & Kayes, 2013). Therefore, the sister should not be financially compensated. Although the law is clear on this, there are reported unethical and black-market practices in kidney transplantation, especially for living unrelated donors.
References
Hinkle, J. L., & Cheever, K. H. (2014). Brunner & Suddarth's textbook of medical-surgical nursing. Lippincott Williams & Wilkins.
Wadhwa, K., & Kayes, O. (2013). Live kidney donation: what are our ethical responsibilities. Trends in Urology & Men's Health, 4(2), 25-28.
