CCTC Living Donor Assessment Process 5 — Questions and Answers
Question 1: Which criterion is considered an absolute contraindication to living kidney donation regardless of other factors?
- Age over 60 years
- HIV-positive status without viral suppression (Correct answer)
- Single episode of kidney stones 10 years ago with no recurrence
- Mild obesity with BMI of 31
Correct answer: HIV-positive status without viral suppression
Uncontrolled HIV infection poses unacceptable risks to the donor and potential transmission risks, making it an absolute contraindication in standard programs.
Question 2: During living donor evaluation, a 24-hour urine collection reveals protein excretion of 450 mg/day. What is the appropriate next step?
- Proceed with donation as this is within acceptable limits
- Exclude the donor immediately as proteinuria exceeds normal limits
- Repeat the test and conduct nephrology evaluation to characterize the proteinuria (Correct answer)
- Request a renal biopsy before making any decision
Correct answer: Repeat the test and conduct nephrology evaluation to characterize the proteinuria
Proteinuria above 300 mg/day is abnormal and warrants nephrology evaluation and test repetition before a final donation decision.
Question 3: A candidate for living liver donation undergoes volumetric analysis. The right lobe graft-to-recipient body weight ratio (GRWR) is 0.7%. What does this indicate?
- The graft is too large for the recipient and may cause small-for-size syndrome
- The graft volume is acceptable and poses no risk
- The graft may be insufficient for the recipient, raising small-for-size syndrome risk (Correct answer)
- The GRWR is irrelevant if total liver volume is adequate
Correct answer: The graft may be insufficient for the recipient, raising small-for-size syndrome risk
A GRWR below 0.8% is associated with small-for-size syndrome in the recipient, indicating the graft may be insufficient to meet metabolic demands.
Question 4: Which professional is primarily responsible for ensuring that a living donor's insurance coverage and financial protections are addressed before donation proceeds?
- The transplant surgeon
- The transplant coordinator (Correct answer)
- The recipient's insurance case manager
- The hospital billing department
Correct answer: The transplant coordinator
The transplant coordinator is responsible for coordinating all aspects of donor care including financial counseling and insurance review.
Question 5: A living donor candidate has a first-degree relative with autosomal dominant polycystic kidney disease (ADPKD). What is the most important step in her evaluation?
- Exclude her immediately due to hereditary risk
- Proceed without additional testing since she is currently asymptomatic
- Perform genetic counseling and imaging to rule out early disease manifestation (Correct answer)
- Request only a creatinine level to assess renal function
Correct answer: Perform genetic counseling and imaging to rule out early disease manifestation
First-degree relatives of ADPKD patients are at 50% genetic risk; imaging and genetic counseling are needed to rule out early cyst development before donation.
Question 6: What is the recommended minimum age for a living organ donor in the United States per OPTN policy?
- 16 years of age with parental consent
- 18 years of age (Correct answer)
- 21 years of age
- 25 years of age
Correct answer: 18 years of age
OPTN policy requires living donors to be at least 18 years old to ensure legal capacity for informed consent.
Question 7: After completing the full medical and psychosocial evaluation, who has the final authority to approve or decline a living donor candidate?
- The transplant coordinator who managed the evaluation
- The multidisciplinary transplant selection committee (Correct answer)
- The recipient's transplant surgeon alone
- The hospital ethics board in all cases
Correct answer: The multidisciplinary transplant selection committee
The multidisciplinary selection committee reviews all evaluation data and holds collective final authority over donor approval decisions.
CCTC Living Donor Assessment Process 5
Which criterion is considered an absolute contraindication to living kidney donation regardless of other factors?