CCTC Living Donor Assessment Process 2 — Questions and Answers
Question 1: During the psychosocial evaluation of a living donor candidate, which finding would most likely result in exclusion from donation?
- Mild anxiety about the surgery
- Active untreated psychiatric disorder affecting decision-making (Correct answer)
- History of resolved depression with stable medications
- Moderate concern about recovery time
Correct answer: Active untreated psychiatric disorder affecting decision-making
An active untreated psychiatric disorder that impairs decision-making capacity disqualifies a candidate because informed consent requires intact judgment.
Question 2: What is the primary purpose of the independent donor advocate (IDA) in the living donor evaluation process?
- To advocate for the recipient's need for a transplant
- To ensure the donor's interests are represented separately from the transplant team (Correct answer)
- To expedite the evaluation timeline for the transplant center
- To coordinate insurance coverage for the donor's surgery
Correct answer: To ensure the donor's interests are represented separately from the transplant team
The IDA is specifically designated to protect and represent the donor's interests, independent of the transplant team's goals.
Question 3: A potential living kidney donor has a GFR of 68 mL/min/1.73m². How should the transplant coordinator interpret this finding?
- Automatically exclude the donor as GFR is too low
- Accept the donor without further evaluation
- Consider it borderline and consult nephrology for individualized risk assessment (Correct answer)
- Proceed only if the donor is under age 30
Correct answer: Consider it borderline and consult nephrology for individualized risk assessment
A GFR of 68 is borderline low for donation and requires individualized nephrology consultation to assess long-term donor risk.
Question 4: Which imaging study is most commonly used to evaluate living donor kidney anatomy prior to nephrectomy?
- Renal ultrasound alone
- CT angiography of the abdomen and pelvis (Correct answer)
- MRI with gadolinium contrast
- Intravenous pyelogram (IVP)
Correct answer: CT angiography of the abdomen and pelvis
CT angiography provides detailed visualization of vascular anatomy, collecting system, and parenchymal structure critical for surgical planning.
Question 5: When assessing a living liver donor, which remnant liver volume is generally considered the minimum safe threshold for the donor?
- 15% of total liver volume
- 20% of total liver volume
- 30% of total liver volume (Correct answer)
- 40% of total liver volume
Correct answer: 30% of total liver volume
A remnant liver volume of at least 30% is generally required to ensure adequate hepatic function and safe recovery for the donor.
Question 6: A living donor candidate discloses she is in a financial relationship where the recipient's family is paying her rent. What is the appropriate next step?
- Proceed with evaluation as financial arrangements are legal
- Immediately exclude the candidate for financial incentive
- Report the arrangement to the ethics committee and conduct further assessment for coercion (Correct answer)
- Document the finding and continue without further action
Correct answer: Report the arrangement to the ethics committee and conduct further assessment for coercion
Financial arrangements between donor and recipient raise coercion concerns and must be reviewed by the ethics committee before proceeding.
Question 7: Which blood pressure threshold is most widely used as a contraindication to living kidney donation in an otherwise healthy candidate?
- BP consistently above 130/80 mmHg uncontrolled
- BP consistently above 140/90 mmHg despite optimal treatment with multiple agents (Correct answer)
- Any episode of elevated BP in the past year
- BP above 120/80 mmHg on two readings
Correct answer: BP consistently above 140/90 mmHg despite optimal treatment with multiple agents
Uncontrolled hypertension requiring multiple medications raises long-term renal risk for the donor and is generally considered a contraindication.
CCTC Living Donor Assessment Process 2
During the psychosocial evaluation of a living donor candidate, which finding would most likely result in exclusion from donation?