CCTC Waitlist Management and Allocation 5

Question 1

A 16-year-old kidney transplant candidate has been on dialysis for 3 years and 2 months. Due to a surgically correctable vascular access complication, she is placed on inactive (Status 7) for 5 months while awaiting repair and recovery. Upon reactivation, how is her waiting time calculated under the Kidney Allocation System (KAS)?

Accepted Answer

Her waiting time is based on her dialysis initiation date and continues to accrue throughout inactive periods, making the 5-month inactive interval irrelevant to her waiting time total

Answer

Under KAS (implemented 2014), kidney waiting time is anchored to the patient's dialysis initiation date — not their listing date or active-status periods. This dialysis-based waiting time accrues continuously regardless of active or inactive status. This is a critical distinction from other organ systems where inactive time does not count. Her 3 years and 7 months of dialysis time (including the inactive period) is her full waiting time credit.

Question 2

A heart failure patient is listed at UNOS Status 2 due to dependence on an intra-aortic balloon pump (IABP). After stabilization, the IABP is weaned, a continuous-flow LVAD is successfully implanted, and the patient is discharged home in stable condition with no device-related complications. What is the correct UNOS status reclassification?

Accepted Answer

The patient is reclassified to Status 3, as a clinically stable, dischargeable continuous-flow LVAD without complications meets the Status 3 criteria under the 2018 heart allocation policy

Answer

Under the UNOS 2018 six-tier heart allocation policy, Status 1 applies to non-dischargeable devices (e.g., BiVAD, ECMO, TAH, or LVAD with life-threatening complications). Status 2 includes IABP or LVAD with device malfunction/complications. A patient with a functioning, dischargeable continuous-flow LVAD who is clinically stable and sent home falls squarely into Status 3. Misclassifying this patient as Status 1 or 2 would be a policy violation.

Question 3

Under the OPTN 'Share 35' liver allocation policy, which of the following most accurately describes the allocation sequence when a donor liver becomes available and a local candidate has a MELD score of 38?

Accepted Answer

Local Status 1A and 1B candidates are offered the organ first; then regional candidates with MELD ≥35 are offered the organ before local candidates with MELD <35

Answer

Share 35 (implemented 2013) requires that livers be offered regionally to candidates with MELD ≥35 before local candidates with MELD <35 — but it does not override the absolute highest-priority status designations. Local Status 1A (acute liver failure, ICU-level) and Status 1B (pediatric acute/chronic) candidates retain first priority above regional Share 35 offers. The local MELD 38 candidate would receive consideration after regional MELD ≥35 candidates take their queue position, unless that local candidate is also Status 1A/1B.

Question 4

An 8-year-old child is listed for liver transplantation secondary to biliary atresia with progressive synthetic dysfunction. Her clinical team calculates her priority score. Which scoring system applies, and which variable included in that system does NOT appear in the standard adult MELD formula?

Accepted Answer

PELD; growth failure (height or weight more than 2 standard deviations below the mean for age and sex) is a variable that adds points and has no equivalent in the adult MELD formula

Answer

PELD (Pediatric End-Stage Liver Disease) applies to liver candidates under 12 years of age. Like MELD, it incorporates INR and bilirubin, but PELD replaces creatinine with albumin and adds two pediatric-specific variables: age <1 year (adds ~0.436 points) and growth failure — defined as height or weight >2 standard deviations below the age- and sex-adjusted mean — which adds approximately 0.667 points. Neither growth failure nor albumin appears in the standard MELD or MELD-Na formula, making growth failure the most uniquely pediatric element.

Question 5

A highly sensitized kidney candidate (calculated PRA 97%) receives a deceased donor offer. The virtual crossmatch, using the donor's HLA typing against the recipient's unacceptable antigen list, is negative (compatible). Due to donor instability and logistical constraints, a prospective physical crossmatch cannot be completed within the organ viability window. What does current OPTN policy support regarding proceeding with transplantation?

Accepted Answer

The transplant center may proceed based on virtual crossmatch results; while a prospective physical crossmatch is preferred, OPTN policy does not categorically prohibit acceptance when virtual crossmatch is negative and logistics prevent physical crossmatch

Answer

OPTN policy does not impose an absolute requirement for a prospective physical crossmatch in all cases. Virtual crossmatch — using the donor's HLA type against the recipient's documented unacceptable antigens — is accepted as the basis for transplant decisions, particularly when viability constraints make physical crossmatch logistically impossible. The transplant program retains responsibility for the clinical decision and must document the rationale. This reflects the evolution of transplant immunology where high-resolution virtual crossmatch has proven reliable for identifying donor-specific antibody risk.

CCTC - Certified Clinical Transplant Coordinator Practice Test

CCTC - Certified Clinical Transplant Coordinator Practice Test

CCTC Waitlist Management and Allocation 5