CTP Donor & Recipient Evaluation 3 — Questions and Answers
Question 1: A donor is found to have a hepatocellular carcinoma (HCC) incidentally discovered at procurement. Which organ may still be considered for transplantation in most protocols?
- Liver
- Kidneys (Correct answer)
- Heart
- Pancreas
Correct answer: Kidneys
Kidneys are generally considered low risk for HCC transmission because primary liver malignancies rarely metastasize to the kidneys prior to procurement.
Question 2: Which hemodynamic parameter is used to guide fluid resuscitation during donor management to optimize organ perfusion?
- Central venous pressure (CVP) of 4–10 mmHg (Correct answer)
- Mean arterial pressure below 50 mmHg
- CVP above 20 mmHg
- Systolic blood pressure of 80 mmHg
Correct answer: Central venous pressure (CVP) of 4–10 mmHg
Maintaining CVP between 4–10 mmHg in brain-dead donors helps optimize cardiac preload without causing pulmonary edema.
Question 3: Donor-derived transmission of which organism is a well-documented risk requiring recipient prophylaxis in the early post-transplant period?
- Toxoplasma gondii (Correct answer)
- Mycobacterium tuberculosis
- Nocardia asteroides
- Aspergillus fumigatus
Correct answer: Toxoplasma gondii
Toxoplasma gondii can be transmitted from a seropositive donor heart to a seronegative recipient, necessitating post-transplant prophylaxis with TMP-SMX.
Question 4: In the context of expanded criteria donor (ECD) kidneys, which recipient group benefits most from use of these organs?
- Young recipients with rare HLA types
- Older recipients with shorter expected remaining dialysis-free survival (Correct answer)
- Highly sensitized recipients with high PRA
- Pediatric recipients under 12 years
Correct answer: Older recipients with shorter expected remaining dialysis-free survival
Older recipients on dialysis gain survival benefit from ECD kidneys because even marginal kidney function often exceeds the mortality risk of remaining on dialysis.
Question 5: Which viral infection in a potential organ donor requires special disclosure to the transplant team and may restrict organ use to consenting recipients?
- Past cytomegalovirus (CMV) infection
- Active West Nile virus (WNV) infection (Correct answer)
- History of resolved hepatitis A
- Latent Epstein-Barr virus
Correct answer: Active West Nile virus (WNV) infection
Active WNV infection in a donor can be transmitted through organs and carries significant neurological morbidity; use is restricted to life-threatening situations with recipient consent.
Question 6: What is the primary purpose of performing a crossmatch between donor lymphocytes and recipient serum before transplantation?
- To confirm ABO blood group compatibility
- To detect pre-formed donor-specific antibodies that could cause hyperacute rejection (Correct answer)
- To assess the recipient's overall immune function
- To determine cytomegalovirus serostatus
Correct answer: To detect pre-formed donor-specific antibodies that could cause hyperacute rejection
The crossmatch identifies pre-formed donor-specific antibodies (DSAs) in recipient serum that would bind donor antigens and cause hyperacute or accelerated rejection.
Question 7: A donor's urine output drops to 20 mL/hr despite adequate hydration and dopamine. Which additional intervention is most appropriate?
- Initiate vasopressin infusion (Correct answer)
- Begin furosemide infusion without further evaluation
- Proceed immediately to procurement
- Administer mannitol 200 g IV bolus
Correct answer: Initiate vasopressin infusion
Vasopressin (ADH) replacement is indicated in brain-dead donors with diabetes insipidus, which commonly causes oliguria and hemodynamic instability.
CTP Donor & Recipient Evaluation 3
A donor is found to have a hepatocellular carcinoma (HCC) incidentally discovered at procurement.
Which organ may still be considered for transplantation in most protocols?