CCTC Living Donor Assessment Process 3 — Questions and Answers
Question 1: During cardiovascular risk assessment for a living donor, which finding would typically prompt exclusion from donation?
- Occasional palpitations with normal Holter monitor
- Recent myocardial infarction within the past 6 months (Correct answer)
- Well-controlled hypertension on a single agent
- Mildly elevated cholesterol managed with diet
Correct answer: Recent myocardial infarction within the past 6 months
A recent MI indicates significant cardiovascular instability that poses unacceptable surgical and anesthetic risk for a living donor.
Question 2: What does ABO compatibility testing determine in the living donor evaluation?
- Whether the donor and recipient share HLA antigens
- Whether the donor's blood type is compatible for organ transplantation (Correct answer)
- The degree of crossmatch reactivity between donor and recipient
- The donor's risk for post-donation renal failure
Correct answer: Whether the donor's blood type is compatible for organ transplantation
ABO compatibility testing confirms that donor and recipient blood types are compatible to prevent hyperacute rejection.
Question 3: Which urinalysis finding in a living kidney donor candidate would most warrant further nephrological workup?
- Trace proteinuria on a single dipstick after vigorous exercise
- Persistent microalbuminuria on two or more occasions (Correct answer)
- Transient hematuria during a urinary tract infection that resolved
- Specific gravity of 1.015 in a morning sample
Correct answer: Persistent microalbuminuria on two or more occasions
Persistent microalbuminuria suggests subclinical kidney disease and requires nephrology evaluation before clearing a candidate for donation.
Question 4: A living donor candidate is found to have a solitary kidney on imaging despite having two normal kidneys on prior records. What is the most appropriate action?
- Exclude immediately as a solitary kidney is an absolute contraindication
- Proceed with donation of the remaining kidney after confirming function
- Repeat the imaging to rule out technical error before making any decision (Correct answer)
- Refer to urology for kidney reimplantation of the missing kidney
Correct answer: Repeat the imaging to rule out technical error before making any decision
Before any clinical decision, the imaging finding should be confirmed with repeat or alternate imaging to rule out technical artifact.
Question 5: When does the UNOS Living Donor Follow-Up policy require transplant centers to collect and submit follow-up data on living donors?
- At 6 months only
- At 6 months, 1 year, and 2 years post-donation (Correct answer)
- Annually for the donor's lifetime
- At discharge only
Correct answer: At 6 months, 1 year, and 2 years post-donation
UNOS/OPTN policy mandates follow-up data collection at 6 months, 1 year, and 2 years post-donation to monitor donor outcomes.
Question 6: Which infectious disease screening test is mandatory for all living organ donors in the United States per OPTN policy?
- Hepatitis A IgG antibody
- HIV antibody/antigen combination test (Correct answer)
- Toxoplasma IgG
- West Nile Virus IgM
Correct answer: HIV antibody/antigen combination test
HIV screening via combination antibody/antigen test is mandatory for all living donors under OPTN policy to prevent disease transmission.
Question 7: A living donor candidate reports smoking one pack per day for 15 years. What is the most appropriate coordinator recommendation?
- Immediately exclude the candidate due to smoking history
- Accept the candidate without modification since smoking is not a contraindication
- Counsel cessation, set a target quit date, and reassess after confirmed abstinence (Correct answer)
- Allow donation only for a laparoscopic approach to minimize risk
Correct answer: Counsel cessation, set a target quit date, and reassess after confirmed abstinence
Smoking significantly increases perioperative and long-term renal risk; cessation counseling with reassessment after confirmed abstinence is the standard approach.
CCTC Living Donor Assessment Process 3
During cardiovascular risk assessment for a living donor, which finding would typically prompt exclusion from donation?