CCTC - Certified Clinical Transplant Coordinator Living Donor Assessment Process Questions and Answers — Questions and Answers
Question 1: A potential living kidney donor expresses significant fear and anxiety about the surgery during the psychosocial evaluation. However, they insist on proceeding because they feel an immense obligation to their sibling, the recipient. Which of the following is the MOST appropriate next step for the transplant coordinator?
- Document the donor's anxiety and proceed with the evaluation as the donor has consented.
- Recommend the donor and recipient attend joint counseling to resolve the issue.
- Engage the Independent Living Donor Advocate (ILDA) to meet with the donor to explore their feelings and ensure their decision is voluntary. (Correct answer)
- Inform the recipient's team that the donor is ambivalent and suggest pausing the recipient's workup.
Correct answer: Engage the Independent Living Donor Advocate (ILDA) to meet with the donor to explore their feelings and ensure their decision is voluntary.
The primary responsibility in the living donor assessment is to protect the potential donor's autonomy and ensure their decision is free from coercion or undue pressure. The Independent Living Donor Advocate (ILDA) is a crucial team member whose role is to promote the donor's best interests and advocate for their rights. When a donor expresses significant fear but feels a strong obligation, it's a critical point to ensure voluntariness. The ILDA is specifically trained to explore these feelings in a confidential setting, separate from the recipient's team, to ensure the donor's decision is truly their own.
Question 2: Which of the following is considered an absolute contraindication for living kidney donation according to most transplant center guidelines?
- Body Mass Index (BMI) of 32 kg/m2
- History of well-controlled hypertension on one medication in a 55-year-old
- Age of 68 with excellent renal function
- A diagnosis of Type 1 Diabetes Mellitus (Correct answer)
Correct answer: A diagnosis of Type 1 Diabetes Mellitus
Diabetes mellitus, particularly Type 1, is considered an absolute contraindication for living kidney donation. This is because the donor is at a significantly increased long-term risk of developing diabetic nephropathy in their remaining kidney. While BMI, controlled hypertension, and advanced age are relative contraindications that require careful evaluation, they do not automatically exclude a candidate in the way an existing diagnosis of diabetes does.
Question 3: During the informed consent process for a potential living donor, what must be disclosed regarding the confidentiality of their evaluation results?
- All evaluation results will be shared with the transplant recipient to ensure full transparency.
- The reason for medical or psychosocial unsuitability will be provided to the recipient's family to manage expectations.
- The potential donor's evaluation results are kept confidential, and if they choose to withdraw or are found unsuitable, a general, non-specific reason is typically provided to the recipient. (Correct answer)
- Confidentiality is waived if the donor is a close blood relative of the recipient.
Correct answer: The potential donor's evaluation results are kept confidential, and if they choose to withdraw or are found unsuitable, a general, non-specific reason is typically provided to the recipient.
Protecting the potential donor's confidentiality and their right to withdraw at any time without pressure is a cornerstone of the living donor assessment process. Transplant programs ensure that the donor's medical and psychosocial evaluation details are not shared with the recipient. If the donation does not proceed, the recipient is typically told only that the donor was not suitable, without specific details, to protect the donor's privacy and their relationship with the recipient.
Question 4: A transplant coordinator is reviewing the lab work for a 45-year-old potential living kidney donor. Which of the following findings would require the most immediate and thorough investigation before proceeding?
- Serum creatinine of 0.9 mg/dL
- Fasting blood glucose of 95 mg/dL
- Persistent microscopic hematuria on multiple urinalyses (Correct answer)
- Blood pressure reading of 125/80 mmHg
Correct answer: Persistent microscopic hematuria on multiple urinalyses
Persistent microscopic hematuria (blood in the urine) is a potential sign of underlying kidney disease. While the other values listed are within normal limits, hematuria requires a significant workup, which may include a cystoscopy or kidney biopsy, to rule out conditions like IgA nephropathy, thin basement membrane disease, or other glomerular diseases that could increase the donor's long-term risk. The primary goal of the medical evaluation is to identify any unforeseen kidney disease.
Question 5: The comprehensive psychosocial evaluation of a potential living donor is mandated to be performed by which of the following professionals?
- The primary transplant surgeon
- A licensed clinical social worker, psychologist, or psychiatrist (Correct answer)
- The recipient's primary care physician
- The living donor coordinator
Correct answer: A licensed clinical social worker, psychologist, or psychiatrist
OPTN/UNOS policy and standard transplant practice require that the psychosocial evaluation be conducted by a qualified mental health professional, such as a licensed social worker, psychologist, or psychiatrist, who is experienced in transplantation. This ensures a thorough assessment of the donor's understanding, motivations, emotional stability, and ability to cope with the stresses of donation.
Question 6: A non-directed (altruistic) living donor is undergoing assessment. As part of the informed consent process, which of the following points is uniquely critical to discuss with this type of donor?
- The possibility of surgical complications like infection or bleeding.
- The requirement for post-donation follow-up care at 6, 12, and 24 months.
- The fact that the transplant program will determine the recipient of the organ. (Correct answer)
- The potential for post-operative pain and the plan for its management.
Correct answer: The fact that the transplant program will determine the recipient of the organ.
While all donors must be informed about surgical risks, follow-up care, and recovery, it is uniquely important for a non-directed donor to understand that they have no control over who receives their organ. The transplant center's allocation policies, based on factors like the recipient's medical urgency and compatibility, will determine the recipient. This lack of influence over the organ's destination is a key component of the consent process for altruistic donors.
CCTC - Certified Clinical Transplant Coordinator Living Donor Assessment Process Questions and Answers
A potential living kidney donor expresses significant fear and anxiety about the surgery during the psychosocial evaluation.
However, they insist on proceeding because they feel an immense obligation to their sibling, the recipient.
Which of the following is the MOST appropriate next step for the transplant coordinator?