CCTC Organ Procurement and Preservation 6

Question 1

A donor heart is being preserved using static cold storage. The surgical team encounters an unexpected delay and the ischemic time is approaching 5 hours. Which intervention is MOST likely to mitigate ischemia-reperfusion injury upon implantation?

Accepted Answer

Supplementing the preservation solution with a nitric oxide donor prior to implantation

Answer

Nitric oxide donors (e.g., nitroglycerin or SNAP) added to preservation solutions have been shown to reduce ischemia-reperfusion injury by attenuating vasoconstriction, platelet aggregation, and neutrophil adhesion during reperfusion. Warming the organ accelerates metabolic activity and worsens ischemic injury. Retrograde aortic perfusion is not a standard salvage technique during transport, and intrabag steroid administration lacks evidence and risks contamination.

Question 2

During evaluation of a potential kidney donor after circulatory death (DCD), you note the functional warm ischemia time (fWIT) is 38 minutes. Which factor would MOST critically influence the decision to proceed with procurement?

Accepted Answer

The donor's terminal creatinine of 1.4 mg/dL combined with a fWIT under the center-specific cutoff

Answer

The decision to accept a DCD kidney integrates multiple variables. The terminal creatinine (reflecting baseline renal function) combined with the fWIT relative to the procuring center's protocol threshold is the most operationally critical combined assessment — a rising creatinine alongside prolonged fWIT substantially increases risk of primary non-function. Vasopressor use matters but is not the single critical factor. Age and hypertension history are relevant but secondary. Maastricht III classification describes the circumstance (expected cardiac arrest) but does not by itself determine viability.

Question 3

A liver being preserved in University of Wisconsin (UW) solution shows signs of sinusoidal endothelial cell injury on back-table assessment. Which component of UW solution is specifically intended to prevent this cell type's swelling during cold ischemia?

Accepted Answer

Hydroxyethyl starch (HES)

Answer

Hydroxyethyl starch (HES) in UW solution acts as an oncotic agent to prevent interstitial edema and sinusoidal endothelial cell swelling, which are particularly vulnerable to cold-induced cell swelling. Lactobionate chelates iron to reduce free radical production and acts as an impermeant to limit intracellular edema. Glutathione is an antioxidant targeting reperfusion injury, and adenosine supports energy metabolism — neither specifically targets sinusoidal endothelial swelling.

Question 4

A procurement coordinator is managing a multi-organ donor. The pancreas team requests the aorta be flushed with cold UW solution via an aortic cannula, while the liver team insists on a portal vein flush with Custodiol HTK solution. Which statement BEST describes the evidence-based approach to this conflict?

Accepted Answer

A dual-flush technique using aortic UW and portal HTK is acceptable and used in some centers, with outcomes data supporting either approach for the pancreas

Answer

In multi-organ procurement, a dual-flush approach (aortic UW for abdominal organs, portal HTK for the liver) is practiced in many centers, and comparative studies have not demonstrated clear superiority of one approach for the pancreas — both UW and HTK are used with acceptable outcomes. HTK's low viscosity is an advantage but does not mandate exclusive use. UW solution's high potassium does not cause clinically significant vasoconstriction at flush volumes used in situ. There is no hierarchical rule giving the liver team precedence; coordination between teams is standard.

Question 5

During normothermic regional perfusion (NRP) of a DCD donor prior to organ procurement, the CCTC observes that the perfusate lactate is not clearing after 45 minutes and remains above 8 mmol/L. What is the MOST appropriate interpretation and next step?

Accepted Answer

Persistent high lactate suggests ongoing mesenteric or hepatic ischemia; reassess perfusion cannula position and consider abandoning liver procurement

Answer

In NRP, progressive lactate clearance is used as a functional surrogate for organ viability. Failure to clear lactate (particularly remaining >8 mmol/L) at 45 minutes raises concern for inadequate perfusion — commonly due to cannula malposition, inadequate flow, or underlying ischemic organ injury. Reassessing cannula position is the immediate action; persistent non-clearance may indicate the liver is not viable. Bicarbonate administration treats the pH but not the underlying ischemia, and increasing temperature without adequate perfusion exacerbates ischemic injury. Waiting 90 minutes without reassessment risks damaging viable organs.

CCTC - Certified Clinical Transplant Coordinator Practice Test

CCTC - Certified Clinical Transplant Coordinator Practice Test

CCTC Organ Procurement and Preservation 6