Getting the Go-Ahead
When an intestine from a deceased donor is available, Lifecenter Northwest, the organ procurement organization in the Pacific Northwest region, will call the transplant team.
Both a nurse coordinator and a transplant surgeon are on call 24 hours a day at Seattle Children's Hospital. The coordinator will call the transplant surgeon to discuss the history and condition of the donor to determine if this donor organ would be a good match for your child.
If the organ is a good match, the transplant nurse coordinator will contact you to see if your child is able to undergo the transplantation operation. The coordinator must make sure that your child does not have any new health problems that require delaying transplantation.
Current United Network for Organ Sharing (UNOS) policy requires that the transplant center (the Seattle Children's transplant team) decide whether to accept or turn down the organ within ONE HOUR.
We will make every effort to contact you. We will first call your home phone number. Then we will page you. You must answer all pages that you receive, even if you do not recognize the number.The number may be the coordinator's home or cell phone number. We must also have a list of your contacts (e.g., family, friends, school, work, etc.) to call. We may call the local police to help find you.
When we contact you, the coordinator will discuss:
- If your child is well enough for surgery
- How you will get to the hospital
- How long it will take you to arrive
- When to have your child stop eating and drinking to prepare for surgery
- Where to park and check in at the hospital when you arrive
If we are unable to contact you within one hour, you will miss a very important opportunity for a transplant. The intestine and any other organs will be offered to the next person on the transplant list and your child will remain on the waiting list.
Preparing for Surgery
At the hospital, we will perform blood tests and a chest X-ray to make sure your child's condition is stable enough for surgery.
We will start an intravenous (IV) line to give your child medicines and fluids. An IV is a small needle inserted into your child's arm so that we can easily inject medicines and fluids into a vein.
The time of your child's operation is planned to match the intestine's arrival at Seattle Children's. The intestine cannot live long outside a body, so it must be removed from the donor, transported to Seattle Children's and then transplanted into your child within a few hours.
You may stay with your child until the anesthesiologist has put your child to sleep. Your child will then be taken to the operating room. At that time, you can check in at the Pediatric Intensive Care Unit (PICU) front desk. There, you will be given a pager so that operating room staff can let you know how your child is doing during the surgery.
There are many places for you to wait at the hospital during your child's surgery, including the hospital cafeteria, the chapel, the Family Resource Center and family waiting rooms in the PICU and near the operating room.
Intestine Transplantation Surgery
Once your child is asleep under anesthesia, the transplant team will insert additional IV lines including an arterial line to monitor blood pressure and take blood samples. They will also insert a central venous catheter into a large vein, which delivers larger amounts of medicines and fluids than a regular IV.
Surgeons will take out the diseased parts of your child's intestine. At this time, they will also remove any other diseased organs, most commonly the liver.
Next, the surgeons will attach the donor intestine (and any other donor organs). For the intestine, your child's blood vessels will be sewn to those of the donor organ and then the new intestine will be reconnected at both ends.
During this part of the procedure, the surgeons will also create a temporary opening, called a stoma, in the lower part of the small intestine. This procedure is called an ileostomy, and it gives your child's transplant team easy access to the new intestine through the stoma. It will help the team monitor the transplant and check for signs of rejection. The surgeon will also place a tube at the upper end of the donor intestine near your child's stomach. This tube is called a jejunal tube and reduces pressure in your child's gut, so your child can receive nutrition from food rather than from intravenous total parenteral nutrition (TPN).
The operating room staff will let you know how your child is doing during the surgery. They will contact you through the pager you picked up from the PICU.
After the Surgery
After surgery, your child will go to the PICU. You will be able to be with your child there.
Here are some of the things you may see attached to your child in the PICU:
These monitors check your child's heart rate, respiratory rate, blood pressure and oxygen in the blood.
An endotracheal (ET) tube
This tube was placed in your child's windpipe during the surgery and connected to a ventilator to help your child breathe. The doctors will remove the ET tube when your child no longer needs help breathing.
A nasogastric (NG) tube
This tube passes through the nose and into the stomach, to help drain secretions from the stomach.
Several abdominal drains
These are in your child's stomach area to help remove extra fluid from the surgical site.
This drains urine from the bladder. It measures urine output and checks liver function.
Several IV lines
These lines will be used for pain medications, antibiotics and other fluids that your child will need.
An arterial line
This is to check blood pressure and provide blood samples. The arterial line looks like an IV, but it's in an artery rather than a vein. It will be removed before your child leaves the ICU to move to the Surgical Unit.
A central venous catheter
This is a flexible tube placed in a large vein to give IV fluids and provide blood samples. If your child needs to go home with the catheter still in place, the nurses will teach you how to care for it.
A jejunal tube
This is for enteral (by mouth) feeding. Enteral feeding usually begins one to two weeks after intestine transplant.
A gastrostomy tube
This is from the stomach, for tube feeding. When your child is able to get enough nutrition by mouth, surgeons will remove the tube.
This is in your child's stomach area. The bag is attached to an opening in the stomach area called a stoma, to collect waste. The color and texture of the output in the bag lets the transplant team see how well your child's new intestine is doing. When your child is able to eat by mouth or with tube feedings after surgery, surgeons will close the stoma.
Some of these tubes and lines will be removed when your child leaves the PICU. Others may stay in longer.