CCTC Deceased Donor Evaluation and Brain Death Determination

Question 1

Which of the following best defines Donation after Circulatory Death (DCD)?

Accepted Answer

Organ recovery following withdrawal of life-sustaining treatment and confirmation of circulatory arrest

Answer

DCD (previously called non-heart-beating donation) involves procurement after withdrawal of life-sustaining therapy and confirmation of circulatory death. Unlike standard brain death donors where the heart continues beating until surgical procurement, DCD donors experience cardiac arrest first, resulting in warm ischemia time that affects organ viability assessments.

Question 2

Most U.S. hospital protocols for declaring brain death require which of the following?

Accepted Answer

Two independent physicians, with the transplant team explicitly excluded from making the determination

Answer

Brain death declaration requires two independent physicians (at minimum one with neurological expertise) to prevent conflicts of interest. The transplant team is specifically excluded from the determination to maintain the ethical separation between donor care and recipient care.

Question 3

The PHS Guideline for identifying 'increased infectious disease risk' donors primarily addresses transmission risk for which pathogens?

Accepted Answer

HIV, HCV, and HBV

Answer

PHS guidelines identify donors with recent behaviors (e.g., IV drug use, incarceration, high-risk sexual contact) that increase the probability of HIV, HCV, or HBV infection in the window period before seroconversion. Recipients must receive informed consent acknowledging this increased risk before organs from such donors are transplanted.

Question 4

A potential deceased donor has a serum creatinine of 3.8 mg/dL on ICU admission secondary to hypotension-induced acute kidney injury. After aggressive fluid resuscitation and hemodynamic optimization, creatinine falls to 0.9 mg/dL. Which statement most accurately describes kidney transplant suitability?

Accepted Answer

Kidneys may be suitable; acute kidney injury with functional recovery is not an absolute contraindication

Answer

Acute kidney injury with documented functional recovery does not automatically exclude donor kidneys. Trajectory (improving vs. worsening), cause (reversible vs. chronic), and final function are the critical determinants. AKI from hemodynamic insult that resolves is fundamentally different from chronic kidney disease, and many programs successfully transplant these kidneys.

Question 5

The hormonal resuscitation protocol commonly applied to brain-dead deceased donors (the 'TVCI' or similar protocol) addresses which physiological consequence of brain death?

Accepted Answer

Hypothalamic-pituitary axis dysfunction causing multi-hormonal deficiency

Answer

Brain death disrupts the hypothalamic-pituitary axis, leading to deficiencies in thyroid hormone, vasopressin, cortisol, and insulin. The TVCI protocol (Thyroid hormone, Vasopressin, Corticosteroids, Insulin) replaces these hormones to maintain hemodynamic stability, improving organ function and increasing the number and quality of organs procured.

CCTC - Certified Clinical Transplant Coordinator Practice Test

CCTC - Certified Clinical Transplant Coordinator Practice Test

CCTC Deceased Donor Evaluation and Brain Death Determination