CCTC Waitlist Management and Allocation 3 — Questions and Answers
Question 1: A patient's listed diagnosis changes from non-alcoholic steatohepatitis (NASH) cirrhosis to hepatocellular carcinoma (HCC). What waitlist adjustment may be indicated?
- Application for MELD exception points per OPTN policy (Correct answer)
- Automatic upgrade to Status 1A
- Immediate removal and re-listing under a new diagnosis
- No change; MELD score alone determines priority
Correct answer: Application for MELD exception points per OPTN policy
HCC meeting Milan criteria qualifies for MELD exception points through a standardized OPTN policy, increasing transplant priority beyond the calculated MELD.
Question 2: Under OPTN liver allocation policy, what is the first geographic unit prioritized when a donor liver becomes available?
- Donor service area (DSA)
- Transplant program's local catchment zone
- OPTN region (Correct answer)
- National pool
Correct answer: OPTN region
Following the 2021 Acuity Circles policy, livers are offered in concentric distance-based circles starting locally, replacing the old DSA/regional hierarchy.
Question 3: A pediatric kidney candidate has been waiting 3 years. Under KAS, which priority does this candidate receive against adult candidates?
- Pediatric candidates receive priority over adult candidates for pediatric donor kidneys (Correct answer)
- Pediatric candidates are listed separately with no overlap with adults
- Pediatric candidates receive 100% additional wait time credit
- Pediatric candidates are prioritized only when CPRA exceeds 85%
Correct answer: Pediatric candidates receive priority over adult candidates for pediatric donor kidneys
Under KAS, pediatric donor kidneys are first offered to pediatric candidates before adult candidates, protecting access for younger recipients.
Question 4: What is the significance of the 'inactive' status on the transplant waitlist?
- Wait time does not accrue and the candidate cannot receive an organ offer
- The candidate is removed from the waitlist permanently
- Wait time continues to accrue but organ offers are not made (Correct answer)
- The candidate receives lower-priority organ offers only
Correct answer: Wait time continues to accrue but organ offers are not made
When a candidate is placed inactive, wait time continues to accumulate but the patient will not receive organ offers until reactivated to active status.
Question 5: A transplant coordinator receives a kidney offer for a highly sensitized candidate with a PRA of 98%. What is the most critical pre-acceptance step?
- Virtual or prospective crossmatch to assess compatibility (Correct answer)
- Review of the candidate's social support documentation
- Confirmation of the candidate's insurance authorization
- Assessment of the donor's KDPI score only
Correct answer: Virtual or prospective crossmatch to assess compatibility
For highly sensitized candidates, a virtual crossmatch using donor HLA typing and recipient antibody profile is essential before acceptance to avoid hyperacute rejection.
Question 6: Which criterion would most likely trigger a MELD score exception request for a patient with polycystic liver disease?
- Severe debilitation from massive hepatomegaly despite preserved synthetic function (Correct answer)
- Bilirubin greater than 3 mg/dL on routine labs
- History of spontaneous bacterial peritonitis
- Portal hypertension with esophageal varices
Correct answer: Severe debilitation from massive hepatomegaly despite preserved synthetic function
Polycystic liver disease can cause severe disability from organ bulk without significant hepatic synthetic dysfunction, qualifying for exception points when standard MELD underestimates urgency.
Question 7: A waitlisted thoracic candidate asks about living donor options. Which transplant type has an established living-donor protocol?
- Living-donor lobar lung transplant (Correct answer)
- Living-donor heart transplant
- Living-donor heart-lung transplant
- Living-donor total artificial heart bridge
Correct answer: Living-donor lobar lung transplant
Living-donor lobar lung transplantation, where two donors each contribute a lower lobe, is an established but rare procedure for select candidates.
CCTC Waitlist Management and Allocation 3
A patient's listed diagnosis changes from non-alcoholic steatohepatitis (NASH) cirrhosis to hepatocellular carcinoma (HCC).
What waitlist adjustment may be indicated?