CTBS Donor Screening & Eligibility 4 — Questions and Answers
Question 1: A potential tissue donor has a documented history of Creutzfeldt-Jakob disease (CJD). The correct action is to:
- Exclude the donor from all tissue donation (Correct answer)
- Accept only musculoskeletal tissue, which is not affected
- Exclude only neural tissue such as dura mater
- Request a brain biopsy to confirm diagnosis before deciding
Correct answer: Exclude the donor from all tissue donation
A diagnosis of CJD or any prion disease is an absolute contraindication to tissue donation because prions can be transmitted via multiple tissue types.
Question 2: A deceased donor's medical history reveals that they received human-derived growth hormone before 1985. This is a deferral criterion because:
- Cadaveric human growth hormone produced before 1985 was associated with CJD transmission (Correct answer)
- Early growth hormone formulations contained live HIV
- Pre-1985 growth hormone was derived from animal sources with BSE risk
- The manufacturing process used before 1985 did not inactivate hepatitis B
Correct answer: Cadaveric human growth hormone produced before 1985 was associated with CJD transmission
Cadaveric pituitary-derived human growth hormone used before 1985 has been linked to iatrogenic CJD transmission, making it a permanent deferral criterion.
Question 3: Which of the following malignancies would NOT automatically exclude a donor from all forms of tissue donation under AATB standards?
- Basal cell carcinoma of the skin with no metastasis (Correct answer)
- Leukemia diagnosed 10 years ago with documented remission
- Malignant melanoma
- Primary brain tumor regardless of grade
Correct answer: Basal cell carcinoma of the skin with no metastasis
Basal cell carcinoma confined to the skin with no metastasis is generally not a contraindication for tissue donation because of its very low risk of systemic spread.
Question 4: A donor has a documented history of treated Lyme disease with confirmed resolution. The most appropriate action for the tissue bank is to:
- Review the clinical details and consider the donor eligible if fully resolved (Correct answer)
- Automatically defer the donor due to risk of Borrelia transmission via tissue
- Test the donor specimen with a Lyme-specific PCR before proceeding
- Accept the donor for bone but exclude for cardiovascular tissue
Correct answer: Review the clinical details and consider the donor eligible if fully resolved
Fully treated and resolved Lyme disease is generally not a contraindication for tissue donation; clinical context and documentation of resolution guide the decision.
Question 5: Under AATB standards, a donor's age must be considered when procuring which of the following tissue types due to specific age-related quality criteria?
- Cardiovascular tissue such as heart valves (Correct answer)
- Peripheral nerve allografts
- Cancellous bone chips
- Split-thickness skin grafts
Correct answer: Cardiovascular tissue such as heart valves
Cardiovascular tissue banks apply strict age criteria (typically under 55–60 years) for heart valves because valve leaflet integrity and functionality decline significantly with donor age.
Question 6: Which of the following autopsy findings would most directly raise concern for an undiagnosed systemic infection and lead to tissue donation deferral?
- Splenic enlargement with multiple white pulp nodules (Correct answer)
- Atherosclerotic plaques in the aorta
- Hepatic steatosis (fatty liver) with no fibrosis
- Mild pulmonary emphysema consistent with smoking history
Correct answer: Splenic enlargement with multiple white pulp nodules
Splenomegaly with reactive white pulp nodules is a classic finding in systemic infections and may indicate an active or recent infectious process that would disqualify the donor.
Question 7: A tissue bank is reviewing a donor who has a documented history of West Nile Virus (WNV) infection that resolved 3 years ago. According to standard practice, this donor should be:
- Eligible for donation because past resolved WNV infection is not a contraindication (Correct answer)
- Deferred because WNV can persist in neural tissue indefinitely
- Accepted only for skin and musculoskeletal tissue
- Tested with WNV NAT and deferred if any signal is detected
Correct answer: Eligible for donation because past resolved WNV infection is not a contraindication
Resolved West Nile Virus infection from years prior is not a contraindication to tissue donation; only active or recent infection (within the risk window) triggers deferral.
CTBS Donor Screening & Eligibility 4
A potential tissue donor has a documented history of Creutzfeldt-Jakob disease (CJD).
The correct action is to: