CCTC Ethical and Legal Considerations 2 — Questions and Answers
Question 1: A family member insists on donating a kidney to a relative but privately tells the coordinator they feel coerced by other family members. What is the ethically appropriate next step?
- Proceed with donation since the patient consented verbally
- Notify the transplant surgeon to override the family pressure
- Arrange an independent psychosocial evaluation and ensure private counseling (Correct answer)
- Document the concern and continue the evaluation process without intervention
Correct answer: Arrange an independent psychosocial evaluation and ensure private counseling
An independent evaluation ensures voluntariness of consent and protects the potential donor from coercion.
Question 2: Under UNOS policy, which of the following best describes the concept of 'medical urgency' in organ allocation?
- The candidate's ability to pay for post-transplant care
- The likelihood that a candidate will die or become too sick to benefit without a transplant (Correct answer)
- The candidate's time on the waiting list relative to others
- The geographic proximity of the donor hospital to the recipient center
Correct answer: The likelihood that a candidate will die or become too sick to benefit without a transplant
Medical urgency reflects how critically ill a candidate is and how urgently they need a transplant to survive.
Question 3: A brain-dead patient's legally designated healthcare proxy consents to donation, but adult children object. Who has legal authority to authorize donation?
- The adult children, because they are next of kin
- The attending physician, because the patient is brain dead
- The designated healthcare proxy, as legally authorized decision-maker (Correct answer)
- The hospital ethics committee, which must resolve family disputes
Correct answer: The designated healthcare proxy, as legally authorized decision-maker
A legally designated healthcare proxy holds decision-making authority and supersedes next-of-kin objections.
Question 4: Which federal law requires hospitals to notify their Organ Procurement Organization of all deaths and imminent deaths?
- The National Organ Transplant Act (NOTA)
- The Uniform Anatomical Gift Act (UAGA)
- The Conditions of Participation (CoP) for Medicare/Medicaid (Correct answer)
- The Health Insurance Portability and Accountability Act (HIPAA)
Correct answer: The Conditions of Participation (CoP) for Medicare/Medicaid
CMS Conditions of Participation require hospitals to notify the OPO of all deaths to maximize donor identification.
Question 5: A transplant candidate asks the coordinator to keep a serious medication non-adherence history from the transplant team. How should the coordinator respond?
- Honor the request to maintain patient confidentiality
- Report it only if the non-adherence directly caused organ failure
- Inform the patient that material clinical information must be shared with the team (Correct answer)
- Defer the decision to the patient's primary care physician
Correct answer: Inform the patient that material clinical information must be shared with the team
The coordinator has a duty to share clinically relevant information with the transplant team to ensure safe and equitable allocation.
Question 6: Which ethical principle most directly supports offering a transplant to an older candidate with lower expected graft survival over a younger candidate with higher expected survival?
- Beneficence
- Justice (Correct answer)
- Non-maleficence
- Autonomy
Correct answer: Justice
Justice demands fair access to transplantation regardless of age, balancing utility with equitable distribution.
Question 7: A coordinator discovers that a colleague falsified a recipient's lab values to improve their organ allocation score. What is the most appropriate immediate action?
- Confront the colleague privately before taking further action
- Report the incident to institutional leadership and the OPO compliance department (Correct answer)
- Document the observation and wait for corroborating evidence
- Alert the transplant surgeon only, as they are responsible for the patient
Correct answer: Report the incident to institutional leadership and the OPO compliance department
Falsifying allocation data is a serious ethical and legal violation requiring immediate reporting to institutional and OPO compliance channels.
CCTC Ethical and Legal Considerations 2
A family member insists on donating a kidney to a relative but privately tells the coordinator they feel coerced by other family members.
What is the ethically appropriate next step?