HOTA PARAMETERS OF CASE SUBMISSION FOR LIVER TRANSPLANT

Transcription

1 HOTA PARAMETERS OF CASE SUBMISSION FOR LIVER TRANSPLANT 1. COMPLETE AND DETAILED INTRODUCTION OF BOTH THE PATIENT AND THE INCLUDING: 1- COMPLETE PRESENT ADDRESS 2- CELL NUMBERS OF THE PATIENT, THE AND THEIR FAMILY MEMBERS. 2. CAUSE OF THE LIVER FAILURE OF THE PATIENT. 3. EDUCATION AND JOB STATUS OF BOTH THE PATIENT AND THE. 4. MARITAL STATUS WITH DEPENDENT FAMILY MEMBERS OF BOTH THE (NOTE:- IN CASE OF MARRIED FEMALES EXCLUSION OF PREGNANCY AND BREAST FEEDING SHOULD BE DONE) 5. BLOOD GROUP REPORTS OF THE PATIENT, RELATIVES OF THE. 6. DETAILED HISTORY OF THE PATIENT WITH DUE EMPHASIS ON DIAGNOSIS PROBLEM LIST- ALCOHOL USE ALLERGIES DRUG HISTORY- (a) (b) CHILD PUGH SCORE (DATE) MELD SCORE (DATE) VITALS G.PE. SYSTEMIC. LABS (A) BLOOD INVESTIGATION:- (I) BIOCHEMISTRY:- S.E, RFTs, e GFR, LFTs, GLUCOSE (R) Mg++, CA++, PO4--- (II) FASTING BIOCHEMISTRY:- FASTING GLUCOSE; FASTING LIPID PROFILE (III) HEMATOLOY:- CP CLOTTING PROFILE :- PT, INR, APTT, FIBRINOGEN THROMBO PHILIA SCREEN:- (Optional as per case) PROTEIN C : AC, PROTEIN S (Free) ANTI THROMBIN 3, LUPUS ANTI COAGGULANT FACTOR V, ACTIVATED PROTEIN C RESISTANCE, FACTOR VIII, FACTOR V LEIDEN, PROTHROMBIN MUTATIONS: ANTI CARDIOLIPIN Ig G, ANTICARDIOLIPIN IgM,

2 FACTOR VII (B) VIROLOGY:- HepA IgG, Hep A IgM, Hep Be IgM, H Be Ag, HBsAg, ANTI HCV ANTIBODIES, ANTI HIV I and II, CMV Ig G, CMV IgM EBV Ig M, EBV IgG, HSV I and II Ig G. (C) IMMUNDGLOBULINS:- Ig G, Ig A. IgM (D) TUMOUR MARKERS:- ALFA FETOPROTEIN. CA 19-9, CA CEA (OPTIONAL) (E) OTHER TESTS:- TFTs, IRON. TIBC. (F) COAGGULATION TESTS:- (Optional as per case) BT, HESS TEST, PT, APTT Pt+Control, FECTOR XIII DEFICIENCY SCREENING TEST, APTT pt + ads. plasm APTT Pt. + ads Serum: 7. ETAILED HISTORY OF THE WITH DUE EMPHASIS ON. i.medical HISTORY, SURGICAL HISTORY, MEDICATIONS. ALLERGIES, ALCOHOL USE VITALS G.P.E SYSTEMIC. ii.past HISTORY: BLEEDING / CLOTTING DISRDERS; THROM-BOSIS, HEART DISEASE, STROKE, DM, HTN, LIVER DISEASE, JAUNDICE. MALIGNANCY FAMILY H/O CREUTZ FELDT JAKOB DISEASE (CJD) OR DEMENTIA ETHANOL USE, IV- DRUG USE, SMOKING HISTROY, TRAVEL HISTORY. 8. LABORATORY TESTS FOR BOTH THE PATIENT AND THE VOLUNTARY DONOR ID/CPSP ID OR OTHER CREDENTIAL ID AND (A) URINE R/E REPORT FOR BOTH THE AND THE PATIENT (B) CULTURE REPORTS FOR BOTH THE AND THE PATIENT (I) (II) (III) (IV) (V) BLOOD CULTURE URINE CULTURE NASAL CULTURE THROAT SWAB BAL (OPTIONAL) NOTE:- ALL REPORTS MUST BE SIGNED BY THE CONCERNED DOCTOR, WITH FULL NAME AND PMDC ID/CPSP ID OR OTHER CREDENTIAL ID AND CELL NUMBER 9. DETAILED CHEST X-RAY REPORTS OF BOTH THE PATIENT AND THE

3 10. DETAILED ABDOMINAL AND PELVIC ULTRASOUND REPORTS OF BOTH THE 11. CT SCAN REPORTS/ MRI REPORTS (a) PATIENT: (i) ABDOMINAL CT SCAN REPORT/ MRI REPORT (ii) CHEST CT SCAN REPORT/ MRI REPORT (b) DONOR: (i) ABDOMINAL CT SCAN REPORT / MRI REPORT (LIVER VOLUMETRY) 12. DONOR S ERCP/ MRCP REPORTS 13. DETAILED CARDIOLOGICAL ASSESSMENT REPORTS OF BOTH THE. 1. ECG = OPINION 2. ECHO = EF + VALVULAR FUNCTION 3. CARDIAC SCAN = IF REQUIRED 14. DETAILED ASSESSMENT BY ANAESTHETIST REGARDING FITNESS FOR ANAESTHESIA OF BOTH THE 15. DETAILED ASSESSMENT BY PULMONOLOGIST OF BOTH THE PATIENT AND. (I) VC (II) FVC (III) FEV, RAT10 (IV) PEF (C/MIN) (V) OPINION REGARDING FITNESS FOR SURGERY 16. DENTAL ASSESSMENT OF BOTH THE PATIENT AND THE VOLUNTARY DONOR (Optional as per case) 17. NEPHROLOGICAL ASSESSMENT OF BOTH THE PATIENT AND THE

4 18. REPORT OF UPPER GI - ENDOSCOPY OF THE PATIENT 19. PSYCHIATRIC ASSESSMENT OF BOTH THE PATIENT AND THE 20. ASSESSMENT BY AN EXPERT IN INFECTIOUS DISEASES OF BOTH THE 21. PROPOSED PLAN OF THE SURGEON 1. FOR THE 2. FOR THE PATIENT 22. DETAILED INFORMED EXPLICIT CONSENTS FROM THE PATIENT (OR HIS CLOSE FAMILY MEMBER) AND THE SIGNED BY THE CHIEF EXECUTIVE OF THE HOSPITAL 23. PRE- OPERATIVE MANAGEMENT PLAN OF BOTH THE PATIENT AND THE THE PATIENT: - 1. PROPOSED DURATION OF ADMISSION BEFRORE AND AFTER SURGERY 2. PREPATATIONS 3. MEDICATIONS THE 1. PROPOSED DURATION OF ADMISSION BEFORE AND AFTER SURGERY 2. PREPATATIONS 3. MEDICATIONS ID/CPSP ID OR OTHER CREDENTIAL ID AND CELL NUMBER

5 HOTA PARAMETERS OF CASE SUBMISSION FOR KIDNEY TRANSPLANT 1. COMPLETE AND DETAILED INTRODUCTION OF BOTH THE PATIENT AND THE INCLUDING: 1- COMPLETE PRESENT ADDRESS 2- CELL NUMBERS OF THE PATIENT, THE AND THEIR FAMILY MEMBERS. 2. CAUSE OF THE RENAL FAILURE OF THE PATIENT. 3. EDUCATION AND JOB STATUS OF BOTH THE PATIENT AND THE. 4. MARITAL STATUS WITH DEPENDENT FAMILY MEMBERS OF BOTH THE (NOTE:- IN CASE OF MARRIED FEMALES EXCLUSION OF PREGNANCY AND BREAST FEEDING SHOULD BE DONE) 5. BLOOD GROUP REPORTS OF THE PATIENT, RELATIVES OF THE. 6. TISSUE TYPING REPORTS OF BOTH THE PATIENT AND THE VOLUNTARY DONOR SIGNED BY THE CONCERNED DOCTOR, WITH FULL NAME AND PMDC 7. PRA - REPORT OF THE PATIENT SIGNED BY THE CONCERNED DOCTOR, WITH FULL NAME AND PMDC ID/CPSP ID OR OTHER CREDENTIAL ID AND CELL NUMBER (NOTE:- IN CASE OF ELEVATED PRA%, TREATMENT GIVEN AND ITS RESULT) 8. CROSS MATCH REPORT OF THE 9. DETAILED HISTORY OF THE PATIENT WITH DUE EMPHASIS ON AV - FISTULA, CVP - DOUBLE LUMEN, PERMANENT CATHETER, HEMODIALYSIS. PERITONEAL CATHETERIZATION, PERITONEAL DIALYSIS, JAUNDICE, EPISTAXIS, INFECTIONS, EPILEPSY; PREVIOUS RENAL, BLADDER, AND PROSTATE SURGERIES, OTHER SURGERIES. VITALS - G.P.E - SYSTEMIC. 10. DETAILED HISTORY OF THE WITH DUE EMPHASIS ON INFECTIONS, PREVIOUS SURGERIES, STDs, SMOKING HISTORY. VITALS - G.P.E - SYSTEMIC.

6 11. LABORATORY TESTS FOR BOTH THE PATIENT AND THE VOLUNTARY DONOR (a) (b) (C) NOTE:- CP, S.E., UREA, CREATININE, LFTs, TFTs, BSF, CA++, FASTING LIPID PROFILE, PT, APTT, BT, CT, HB-A1C, MP, DENGUE-PCR (OPTIONAL), S.URIC-ACID, ICTB, MTB-DNA-PCR (MUST FOR THE PATIENT), WIDAL TEST, HBsAg, Anti HCV, HIV, CMV (titers), EBV, VDRL, Hb - ELECTROPHERESIS for THALASEMIA TRAIT (OPTIONAL), SERUM FERRITIN (FOR THE PATIENT), D. DIMERS (FOR THE PATIENT), CREATININE CLEARANCE (FOR THE ), URINARY CREATININE (FOR THE ), 24 Hrs URINARY CALCIUM (FOR THE ), 24 Hrs URINARY URIC ACID (FOR THE ), 24 Hrs URINARY VOLUME (FOR THE ), 24 Hrs URINARY PROTEIN (FOR THE ) URINE R/E REPORT CULTURES REPORT BLOOD CULTURE URINE CULTURE NASAL CULTURE THROAT SWAB BAL (OPTIONAL) ALL REPORTS MUST BE SIGNED BY THE CONCERNED DOCTOR, WITH FULL NAME AND PMDC ID/CPSP ID OR OTHER CREDENTIAL ID AND CELL NUMBER 12. DETAILED CHEST X-RAY REPORTS OF BOTH THE PATIENT AND THE 13. DETAILED ABDOMINAL AND PELVIC ULTRASOUND REPORTS OF BOTH THE 14. (IF INDICATED) RELEVANT REPORTS OF M.R.A. OR ANGIO-CT OF THE 15. IVU REPORT (MUST FOR THE ) 16. DETAILED RENAL SCAN REPORT (MUST FOR THE VOLUNTARY DONOR)

7 17. DETAILED CARDIOLOGICAL ASSESSMENT REPORTS OF BOTH THE 1. ECG = OPINION 2. ECHO = EF + VALVULAR FUNCTION 3. CARDIAC SCAN = IF REQUIRED 18 DETAILED ASSESSMENT BY ANESTHETIST REGARDING FITNESS FOR ANAESTHESIA OF BOTH THE. 19 PROPOSED PLAN OF THE SURGEON 1- FOR THE NEPHRECTOMY (a). LEFT (b). RIGHT 2- FOR THE PATIENT RENAL TRANSPLANT (a). IN LEFT ILIAC FOSSA (b). IN RIGHT ILIAC FOSSA 20. DETAILED INFORMED EXPLICIT CONSENTS FROM THE PATIENT (OR HIS CLOSE FAMILY MEMBER) AND THE SIGNED BY THE CHIEF EXECUTIVE OF THE HOSPITAL 21. PRE - OPERATIVE MANAGEMENT PLAN OF BOTH THE PATIENT AND THE. THE PATIENT:- PROPOSED DURATION OF ADMISSION BEFORE AND AFTER SURGERY HEMODIALYSIS/PERITONEAL DIALYSIS PLASMAPHERESIS IMMUNO SUPRESSION OTHER MEDICATIONS THE :- PROPOSED DURATION OF ADMISSION BEFORE AND AFTER SURGERY MEDICATIONS PREPARATIONS ID/CPSP ID OR OTHER CREDENTIAL ID AND CELL NUMBER