CCTC Waitlist Management and Allocation 5 — Questions and Answers
Question 1: A lung transplant candidate's diagnosis changes from COPD to idiopathic pulmonary fibrosis (IPF). How does this affect LAS calculation?
- Diagnosis group changes, typically resulting in a higher LAS due to greater waitlist mortality for IPF (Correct answer)
- LAS is recalculated using the same formula regardless of diagnosis
- The candidate must be removed and re-listed under the new diagnosis
- IPF candidates are automatically placed in a separate allocation pool
Correct answer: Diagnosis group changes, typically resulting in a higher LAS due to greater waitlist mortality for IPF
LAS uses diagnosis-specific disease groups where IPF (Group D) typically produces higher scores than COPD (Group B) due to substantially higher short-term waitlist mortality.
Question 2: Which situation would require a transplant coordinator to submit a variance request to OPTN?
- Implementing a program-specific protocol that deviates from standard OPTN allocation policy (Correct answer)
- Performing routine waitlist updates within established OPTN guidelines
- Declining an organ offer due to medically documented contraindication
- Reporting a serious adverse event within the required timeframe
Correct answer: Implementing a program-specific protocol that deviates from standard OPTN allocation policy
OPTN variance requests are required when a transplant program wishes to operate under policies that differ from standard OPTN allocation procedures.
Question 3: A coordinator is managing a multi-organ listing (kidney-pancreas). Under allocation policy, how are multi-organ candidates prioritized compared to single-organ candidates?
- Multi-organ candidates receive priority over single-organ kidney candidates for the paired organ (Correct answer)
- Multi-organ candidates are ranked separately on an exclusive multi-organ list only
- Multi-organ candidates receive lower priority to preserve single organs for waiting candidates
- Priority is determined solely by time on the kidney waitlist regardless of additional organ need
Correct answer: Multi-organ candidates receive priority over single-organ kidney candidates for the paired organ
OPTN policy gives simultaneous pancreas-kidney candidates priority over kidney-alone candidates to ensure the pancreas is not wasted if the kidney portion is declined.
Question 4: A transplant coordinator receives a DCD (donation after circulatory death) kidney offer. What unique consideration is most important during organ evaluation?
- Warm ischemia time during the withdrawal-to-procurement interval (Correct answer)
- The donor's GFR trend over the preceding 12 months
- Compatibility of HLA-C antigens with the recipient
- Donor's mechanism of brain injury
Correct answer: Warm ischemia time during the withdrawal-to-procurement interval
DCD kidneys sustain warm ischemic injury during the period between circulatory arrest and cold perfusion, and prolonged warm ischemia significantly increases risk of delayed graft function.
Question 5: A pancreas transplant candidate with Type 1 diabetes has a creatinine of 1.2 and no significant nephropathy. Which listing category applies?
- Pancreas transplant alone (PTA) (Correct answer)
- Simultaneous pancreas-kidney (SPK)
- Pancreas after kidney (PAK)
- Pancreas-liver combined listing
Correct answer: Pancreas transplant alone (PTA)
Pancreas transplant alone (PTA) is appropriate for Type 1 diabetics with preserved kidney function who do not require renal replacement therapy.
Question 6: Under OPTN policy, what is the maximum time a transplant program has to respond to an organ offer before the offer is considered declined?
- 1 hour for kidneys and varies by organ type (Correct answer)
- 30 minutes for all organ types
- 2 hours for all organ types regardless of logistics
- 4 hours, standardized across all solid organs
Correct answer: 1 hour for kidneys and varies by organ type
OPTN specifies organ-specific response windows; kidney programs typically have 1 hour to respond, while heart and lung programs have shorter windows given shorter viable ischemia times.
Question 7: A waitlisted candidate refuses to comply with required clinic visits and lab work for 4 months. What is the coordinator's most appropriate action under OPTN policy?
- Place the candidate on inactive status and document compliance issues in the medical record (Correct answer)
- Remove the candidate from the waitlist immediately
- Continue active listing while counseling the patient about compliance
- Refer the case to UNOS for a determination on continued listing eligibility
Correct answer: Place the candidate on inactive status and document compliance issues in the medical record
OPTN policy requires programs to ensure candidates remain medically suitable; non-compliance with monitoring should prompt inactive status with documented outreach until compliance is restored or listing is withdrawn.
CCTC Waitlist Management and Allocation 5
A lung transplant candidate's diagnosis changes from COPD to idiopathic pulmonary fibrosis (IPF).
How does this affect LAS calculation?