CCTC Organ Procurement and Preservation 5

Question 1

What is the significance of the 'warm ischemia time' in donation after circulatory death (DCD) procurement compared to donation after brain death (DBD)?

Accepted Answer

DCD organs experience functional warm ischemia before cross-clamp, increasing susceptibility to ischemia-reperfusion injury

Answer

In DCD, organs are exposed to a period of functional warm ischemia (hypotension and hypoxia before asystole and cross-clamp) that does not occur in DBD, making DCD organs more vulnerable to ischemia-reperfusion injury.

Question 2

Which organ is typically procured LAST during a multi-organ procurement surgery to allow maximal perfusion time for other organs?

Accepted Answer

Kidneys

Answer

Kidneys are typically procured last because they can tolerate longer cold ischemia times (up to 36 hours), while thoracic organs and the liver require earlier removal due to shorter acceptable ischemic windows.

Question 3

A transplant coordinator is managing a DCD donor who has been withdrawn from life support. After 60 minutes, the donor has not progressed to asystole. What is the standard protocol?

Accepted Answer

Abandon the procurement per standard DCD protocols that specify a maximum observation period

Answer

Standard DCD protocols specify a maximum observation period (typically 60-90 minutes depending on organ type) after which procurement is abandoned to avoid procuring organs with excessive warm ischemia time.

Question 4

What is the role of heparin administration during organ procurement, and when is it typically given?

Accepted Answer

Heparin is administered to the donor before cross-clamp to prevent intravascular clotting in the procured organs

Answer

Heparin is administered intravenously to the donor before aortic cross-clamp to prevent microvascular thrombosis in the organs during the ischemic period, ensuring better perfusion when flushed.

Question 5

Which biomarker measured during normothermic machine perfusion is the most reliable indicator of liver viability?

Accepted Answer

Bile production and lactate clearance

Answer

Bile production demonstrates bile duct and hepatocyte function, while lactate clearance reflects mitochondrial aerobic metabolism; together they are the most validated viability markers during normothermic liver perfusion.

CCTC - Certified Clinical Transplant Coordinator Practice Test

CCTC - Certified Clinical Transplant Coordinator Practice Test

CCTC Organ Procurement and Preservation 5