Offers, Acceptance, And Verification

Question 1

Which organ’s allocation may be denied based on a discovery of cytomegalovirus (CMV)?

Answer 1

Intestine

Question 2

A KDPI of __% or higher requires informed consent from the potential kidney recipient?

Answer 2

85%

Question 3

Additional optional liver acceptance criteria (9 factors)

Answer 3

1. Maximum number of mismatched antigens
2. Minimal acceptance criteria
3. acceptance criteria for expedited offers
4. If a blood type O will accept from a type A (non A¹) donor
5. For status 1A or 1B candidates, if they will accept from a donor of any blood type
6. If a candidate with a MELD/PELD of 30+ will accept from a donor of any blood type
7. If a candidate will accept a liver for other methods of hepatic support
8. If a candidate will accept a segmental graft
9. If a candidate is willing to accept an HIV+ liver as part of an approved research protocol

Question 4

If a candidate is pending a pancreas transplant after having received a kidney transplant, how can histocompatibility be determined/affected?

Answer 4

The kidney DONOR’s antigens can be considered self-antigens, entered alongside the candidate’s own antigens, in the pancreas match runs. Use of these modified mismatch criteria is optional.

Question 5

Order of Allocation (6 steps)

Answer 5

1. The match system eliminates candidates who cannot accept based on size or blood type.
2. The match system ranks candidates according to the allocation sequences in the organ allocation policies
3. OPOs must offer organs to potential recipients in the order they appear on the match run.
4. If no transplant program on the initial match run accepts the organ, the OPO may give programs the opportunity to update candidates’ data with OPTN before repeating the match run.
5. Extra vessels allocated with an organ but not required for transplant can be shared.
6. Members may export donor organs to hospitals in foreign countries only AFTER offering these organs to all PTRs on the match run, as well as submitting an organ export verification form.

Question 6

What is the time frame for an OPO to make a liver offer following a match run?

Answer 6

Liver offers should be made using a match run that is less than 8 hours old. The match run may only be re-executed before 8 hours IF:
1. A previously accepted liver is later refused due to a change in medical information in the donor
2. The liver has not been allocated within 2 hours of procurement
OR
3. New donor information is received that would screen potential recipients from appearing on the match run

Question 7

Transplant programs must respond to backup offers the same as organ offers, meaning they must respond within __________.

Answer 7

1 hour. If a program doesn’t consider or respond to an offer, it is considered refused.

Question 8

2 examples of acceptable reasons for allocation to a candidate who ISN’T on the match run:

Answer 8

1. Directed donation
2. Preventing organ waste

Question 9

What must the transplant hospital document in the case of allocation to a candidate NOT on the match run? (4 components)

Answer 9

1. The reason for transplanting to a candidate not on the match run
2. Why this candidate didn’t appear on the match run
3. Whether this hospital is willing to accept a kidney with KDPI of 85% or higher, if applicable
4. Verification of medical suitability between donor and recipient (blood type+subtype, HLA compatibility, donor height+weight, infectious disease testing, HIV status verification if utilizing the pertinent open variance (policy15.7) for transplant between HIV+ donors+recipients)

Question 10

Organ offer acceptance limit

Answer 10

For any one candidate, the transplant hospital can have up to 2 offer acceptances per organ type.

Question 11

Organ check-in: before opening the organ’s external transport container, what information must the receiving hospital verify? (2 data points)

Answer 11

1. Donor ID
2. Organ type (and laterality if applicable)

(Verification using an approved electronic method is acceptable)

Question 12

Pre-transplant verification: when a recipient surgery is to begin BEFORE receipt of the donor organ in the OR, the hospital’s pre-transplant verification must meet the following requirements: (3 requirements)

Answer 12

1. The intended recipient is present in the OR
2. Verification must take place prior to general anesthesia (or prior to incision if patient was already continuously sedated before entering the OR)
3. Pre-transplant verification of 1. the expected donor ID and expected organ/laterality through the OPTN computer system or recipient medical record 2. Expected Donor and recipient blood type(+subtype if used for allocation) and blood type compatibility through the OPTN system or respective blood typing source documents 3. Recipient unique identifier using recipient identification band.

All must be verified by 2 licensed health care professionals.

Question 13

Pre-transplant verification: UPON ORGAN RECEIPT, what is required of the transplant hospital’s Pre-transplant verification? (3 requirements)

Answer 13

1. The intended recipient must be present in the OR
2. The verification must occur after the organ’s arrival in the OR but prior to anastomosis of the first organ
3. Verification of the following: donor ID via package labels and documentation, organ and laterality upon observation, donor and recipient blood type(+subtype if used for allocation) and blood type compatibility via respective blood type source documents, recipient unique identifier via recipient ID band. This culminates in the verification that the correct donor organ has been identified for the correct recipient.

All must be verified by the transplant surgeon themself, along with a second licensed Healthcare professional.