CCTC Waitlist Management and Allocation 2 — Questions and Answers
Question 1: A patient listed for liver transplant has a MELD score of 25. After a hospitalization for hepatic encephalopathy, which action is most appropriate?
- Recalculate MELD using current labs and update the listing (Correct answer)
- Remove patient from waitlist until fully recovered
- Maintain the previous MELD score until next scheduled update
- Automatically escalate to Status 1A
Correct answer: Recalculate MELD using current labs and update the listing
MELD scores must be updated whenever a patient's clinical status changes, using current laboratory values to reflect true disease severity.
Question 2: Which UNOS policy governs how transplant programs must document patient contact attempts to maintain active waitlist status?
- OPTN Policy 18.1 requiring documented patient contact every 6 months (Correct answer)
- OPTN Policy requiring contact every 3 months for inactive patients
- CMS Conditions of Participation for outpatient follow-up
- Joint Commission standards for transplant program communication
Correct answer: OPTN Policy 18.1 requiring documented patient contact every 6 months
OPTN Policy 18.1 requires transplant programs to document attempts to contact active waitlisted candidates at least every 6 months.
Question 3: A kidney waitlist candidate moves from New York to Los Angeles permanently. What is the transplant coordinator's primary responsibility?
- Transfer the listing to an appropriate program in Los Angeles (Correct answer)
- Keep the listing active in New York since it retains accrued wait time
- Suspend the listing until the patient establishes new residency
- Notify UNOS and allow automatic geographic reassignment
Correct answer: Transfer the listing to an appropriate program in Los Angeles
When a candidate relocates permanently, the coordinator should facilitate transfer to a program where the patient can realistically receive a transplant and comply with follow-up.
Question 4: Under the Kidney Allocation System (KAS), what does the Estimated Post-Transplant Survival (EPTS) score primarily reflect?
- The recipient's predicted long-term graft survival (Correct answer)
- The likelihood of a candidate dying on the waitlist within 5 years
- The donor's organ quality based on Kidney Donor Profile Index
- The recipient's immune sensitization level
Correct answer: The recipient's predicted long-term graft survival
EPTS predicts how long a recipient is expected to benefit from a transplanted kidney, helping match longer-surviving kidneys to candidates expected to live longest.
Question 5: A heart transplant candidate deteriorates and is admitted to the ICU requiring intravenous inotropes. Which status designation applies?
- Status 2
- Status 3
- Status 1A (Correct answer)
- Status 1B
Correct answer: Status 1A
Status 1A includes patients hospitalized with life-threatening hemodynamic compromise requiring mechanical circulatory support or continuous IV inotropes with hemodynamic monitoring.
Question 6: When a deceased donor organ is offered and the transplant coordinator determines the intended recipient is temporarily unavailable (e.g., active infection), what should the coordinator do?
- Decline the organ and document the reason in the waitlist record (Correct answer)
- Accept the organ and proceed regardless of the contraindication
- Transfer the patient to active status and accept the organ
- Contact UNOS to suspend allocation for 24 hours
Correct answer: Decline the organ and document the reason in the waitlist record
If a candidate has a temporary contraindication to transplant, the organ should be declined and the reason documented; the candidate may be placed on hold/inactive status.
Question 7: Which factor is NOT directly used to calculate the Lung Allocation Score (LAS)?
- Recipient's geographic proximity to donor hospital (Correct answer)
- Predicted waitlist survival without transplant
- Predicted post-transplant survival benefit
- Disease diagnosis group
Correct answer: Recipient's geographic proximity to donor hospital
The LAS is calculated from waitlist urgency and transplant benefit measures including diagnosis group, but geographic proximity is a separate matching criterion, not an LAS component.
CCTC Waitlist Management and Allocation 2
A patient listed for liver transplant has a MELD score of 25.
After a hospitalization for hepatic encephalopathy, which action is most appropriate?