CCTC Evaluation and Preparation for Transplant 5 — Questions and Answers
Question 1: Which test is used to definitively confirm brain death in a potential deceased organ donor when clinical criteria alone are insufficient?
- CT scan of the head
- Cerebral blood flow study (nuclear scan or CTA) (Correct answer)
- Electroencephalogram (EEG) with observation
- Lumbar puncture
Correct answer: Cerebral blood flow study (nuclear scan or CTA)
Cerebral blood flow studies (e.g., radionuclide scan or CT angiography) confirm absence of intracranial circulation, serving as an ancillary test when full brain death exam cannot be completed.
Question 2: A transplant coordinator is informed that a liver transplant candidate has developed spontaneous bacterial peritonitis (SBP). How should this affect waitlist management?
- Remove the patient from the waitlist immediately
- Treat the infection and do not list for at least 6 months
- Continue workup; SBP history warrants MELD exception consideration and prophylactic antibiotics post-transplant (Correct answer)
- Transfer care to an infectious disease specialist only
Correct answer: Continue workup; SBP history warrants MELD exception consideration and prophylactic antibiotics post-transplant
SBP is a marker of advanced liver disease and may qualify for MELD exception points; patients require prophylactic antibiotics and active monitoring while listed.
Question 3: When obtaining informed consent for transplant listing, which element must be clearly communicated to the candidate and their family?
- The exact date they will receive a transplant
- The risks, benefits, alternatives, waitlist process, and possibility of not receiving a transplant (Correct answer)
- The identity of potential donors
- The names of all surgical team members
Correct answer: The risks, benefits, alternatives, waitlist process, and possibility of not receiving a transplant
Informed consent for transplant listing must cover surgical risks, expected benefits, alternatives (including dialysis or medical management), organ allocation processes, and uncertainty of organ availability.
Question 4: Which scoring tool is routinely used by transplant coordinators to assess a patient's functional status as part of the pretransplant evaluation?
- Glasgow Coma Scale
- Karnofsky Performance Status or 6-Minute Walk Test (Correct answer)
- Abbreviated Mental Test
- APACHE II score
Correct answer: Karnofsky Performance Status or 6-Minute Walk Test
Karnofsky Performance Status and the 6-Minute Walk Test quantify functional capacity and predict post-transplant rehabilitation potential and outcomes.
Question 5: A kidney transplant candidate has a history of oxalate nephropathy leading to ESRD. What additional organ transplant should be considered during evaluation?
- Heart transplant due to cardiac oxalate deposits
- Combined liver-kidney transplant, as the liver is the primary source of oxalate overproduction in primary hyperoxaluria (Correct answer)
- Pancreas transplant to reduce oxalate absorption
- Intestinal transplant only
Correct answer: Combined liver-kidney transplant, as the liver is the primary source of oxalate overproduction in primary hyperoxaluria
In primary hyperoxaluria, the metabolic defect is in the liver; combined liver-kidney transplant corrects the enzymatic defect and replaces the damaged kidney.
Question 6: Which pretransplant screening test is required by UNOS policy for all organ transplant candidates to protect recipients and guide post-transplant management?
- BRCA gene panel
- Infectious disease serology including HIV, hepatitis B, hepatitis C, CMV, and EBV (Correct answer)
- Full genetic karyotype
- Bone density scan
Correct answer: Infectious disease serology including HIV, hepatitis B, hepatitis C, CMV, and EBV
UNOS policy mandates infectious disease serologies to identify donor-recipient matching risks, guide prophylaxis, and prevent transmission of HIV, hepatitis, CMV, and EBV.
Question 7: A patient being considered for kidney transplant has a positive tuberculin skin test (TST) but no active TB symptoms. What is the appropriate management?
- Deny transplant listing due to infection risk
- Treat with prophylactic isoniazid (INH) pre- or post-transplant per infectious disease guidance before proceeding (Correct answer)
- No action required; latent TB poses no transplant risk
- Delay listing for 5 years after TST result
Correct answer: Treat with prophylactic isoniazid (INH) pre- or post-transplant per infectious disease guidance before proceeding
Latent TB reactivates under immunosuppression, so prophylactic INH treatment is indicated and should be coordinated with infectious disease specialists prior to or shortly after transplant.
CCTC Evaluation and Preparation for Transplant 5
Which test is used to definitively confirm brain death in a potential deceased organ donor when clinical criteria alone are insufficient?