CCTC Organ Procurement and Preservation 4 — Questions and Answers
Question 1: Which preservation solution is most commonly used for pancreas preservation due to its high viscosity and oncotic properties?
- University of Wisconsin (UW) solution (Correct answer)
- Custodiol HTK solution
- Normal saline
- Lactated Ringer's solution
Correct answer: University of Wisconsin (UW) solution
UW solution contains hydroxyethyl starch which provides oncotic support and is the gold standard for pancreas preservation, allowing up to 30 hours of cold ischemia.
Question 2: During back-table preparation of a donor kidney, the transplant coordinator notices the renal artery has an accessory lower pole artery. What is the appropriate action?
- Discard the kidney as it is unsuitable for transplant
- Document and report the finding to the surgical team for reconstruction planning (Correct answer)
- Ligate the accessory artery to simplify anastomosis
- Proceed with procurement without documentation
Correct answer: Document and report the finding to the surgical team for reconstruction planning
Accessory renal arteries must be documented and communicated to the surgical team so they can plan appropriate reconstruction to ensure adequate blood supply to all segments of the kidney.
Question 3: What is the primary purpose of pulsatile machine perfusion (PMP) compared to static cold storage for kidneys?
- It eliminates the need for preservation solution
- It provides continuous flow that may reduce delayed graft function and allows viability assessment (Correct answer)
- It raises the organ temperature to promote cellular repair
- It is used exclusively for pediatric donor kidneys
Correct answer: It provides continuous flow that may reduce delayed graft function and allows viability assessment
Pulsatile machine perfusion maintains continuous flow mimicking physiologic conditions, which may reduce ischemia-reperfusion injury and allows real-time monitoring of renal resistance and flow as viability markers.
Question 4: A donor is declared brain dead and consent is obtained. Before organ procurement, the coordinator notes the donor's creatinine has risen from 0.9 to 2.8 mg/dL over 24 hours. What is the best course of action?
- Automatically decline the kidneys for transplant
- Notify the transplanting surgeon and OPO medical director to evaluate the clinical context (Correct answer)
- Proceed without notification as minor creatinine elevation is expected post-brain death
- Cancel the entire procurement
Correct answer: Notify the transplanting surgeon and OPO medical director to evaluate the clinical context
Rising creatinine in brain-dead donors is common due to hemodynamic instability and requires clinical context evaluation; the decision to accept or decline organs rests with the transplanting surgeon in collaboration with the OPO medical director.
Question 5: What is the maximum recommended cold ischemia time for a donor liver to minimize primary non-function risk?
- 6 hours
- 12 hours (Correct answer)
- 24 hours
- 36 hours
Correct answer: 12 hours
Liver cold ischemia time should ideally be kept under 12 hours, as times exceeding this threshold significantly increase the risk of primary non-function and ischemic cholangiopathy.
Question 6: Which technique is used to assess the viability of a marginal donor liver prior to transplantation using a normothermic circuit?
- Hypothermic machine perfusion (HMP)
- Normothermic regional perfusion (NRP) or normothermic machine perfusion (NMP) (Correct answer)
- Static cold storage with UW solution
- Warm ischemia tolerance testing
Correct answer: Normothermic regional perfusion (NRP) or normothermic machine perfusion (NMP)
Normothermic machine perfusion restores near-physiologic conditions allowing the liver to produce bile and metabolize lactate, providing functional viability assessment not possible with static cold storage.
Question 7: Under UNOS/OPTN policy, which circumstance requires a coordinator to notify the potential recipient center of a change in donor status during procurement?
- Only if the donor develops cardiac arrest before cross-clamp
- Any significant change in donor clinical status, serology results, or organ quality discovered during procurement (Correct answer)
- Only changes identified after cross-clamp
- Changes are reported only after transplant when post-procurement biopsies are finalized
Correct answer: Any significant change in donor clinical status, serology results, or organ quality discovered during procurement
UNOS/OPTN policy mandates timely communication of any significant change in donor information that could affect organ suitability or recipient risk to all accepting transplant programs.
CCTC Organ Procurement and Preservation 4
Which preservation solution is most commonly used for pancreas preservation due to its high viscosity and oncotic properties?