CTP Donor & Recipient Evaluation 5 — Questions and Answers
Question 1: Which laboratory finding in a potential pancreas donor is considered the most concerning for pre-existing pancreatic dysfunction?
- Serum amylase 250 U/L after vasopressor use
- Hemoglobin A1c greater than 6.5% (Correct answer)
- Serum lipase 180 U/L with no abdominal trauma
- Blood glucose of 160 mg/dL on dextrose infusion
Correct answer: Hemoglobin A1c greater than 6.5%
An HbA1c greater than 6.5% indicates pre-existing diabetes in the donor, which is a contraindication to pancreas procurement for islet or whole-pancreas transplantation.
Question 2: In evaluating a pediatric donor for organ donation, which anatomical consideration is most important when matching to a recipient?
- Recipient's HLA match percentage
- Size and weight compatibility between donor and recipient (Correct answer)
- Recipient's dialysis vintage
- Donor's serum sodium level
Correct answer: Size and weight compatibility between donor and recipient
Size matching is critical for pediatric donors because organ-to-body size mismatch can lead to technical complications such as vascular thrombosis or poor engraftment.
Question 3: A donor has nucleic acid testing (NAT) positive for HCV RNA. Which recipient population may still receive organs from this donor under current UNOS policy?
- Only HCV RNA-positive recipients
- HCV-negative recipients who provide informed consent under specific protocols (Correct answer)
- Only recipients with fulminant hepatic failure
- No recipients — HCV NAT+ donors are universally excluded
Correct answer: HCV-negative recipients who provide informed consent under specific protocols
With effective direct-acting antiviral therapy, NAT+ HCV donor organs may be transplanted into HCV-negative recipients who provide informed consent, per evolving UNOS/OPTN policy.
Question 4: During neurological determination of death (NDD), which finding confirms the absence of brainstem reflexes as part of the clinical examination?
- Absence of spontaneous respirations on apnea test with PCO2 >60 mmHg (Correct answer)
- Flat EEG recording for 30 minutes
- Core body temperature below 35°C
- Dilated pupils on CT scan
Correct answer: Absence of spontaneous respirations on apnea test with PCO2 >60 mmHg
A positive apnea test — no spontaneous respiratory effort with PaCO2 rising above 60 mmHg — confirms absence of medullary respiratory drive and supports brain death determination.
Question 5: When evaluating a recipient candidate for simultaneous liver-kidney transplantation (SLK), which criterion is used to justify the kidney addition under current UNOS policy?
- Creatinine >1.5 mg/dL at listing
- Sustained AKI or CKD with GFR ≤60 mL/min for ≥90 days, or ESRD on dialysis (Correct answer)
- Any history of acute kidney injury
- Proteinuria >500 mg/day
Correct answer: Sustained AKI or CKD with GFR ≤60 mL/min for ≥90 days, or ESRD on dialysis
UNOS SLK allocation policy requires sustained renal impairment (GFR ≤60 for ≥90 days, ESRD, or prolonged AKI) to justify using a kidney with the liver.
Question 6: Which virological test result in a potential donor mandates automatic organ discard per most OPO protocols, regardless of organ type?
- CMV IgG positive
- HIV RNA NAT positive (confirmed active HIV infection) (Correct answer)
- EBV IgG positive
- HSV IgG positive
Correct answer: HIV RNA NAT positive (confirmed active HIV infection)
Confirmed active HIV infection (HIV RNA NAT positive) in a donor is an absolute contraindication to donation outside of the HIV Organ Policy Equity (HOPE) Act research protocols.
Question 7: In the evaluation of a potential liver donor with a fatty liver (steatosis), which biopsy finding best predicts poor post-transplant graft function?
- Macrovesicular steatosis >30% on biopsy (Correct answer)
- Microvesicular steatosis <10%
- Mild periportal fibrosis (stage 1)
- Lobular inflammation grade 1
Correct answer: Macrovesicular steatosis >30% on biopsy
Macrovesicular steatosis exceeding 30% is associated with significantly increased risk of primary non-function and early allograft dysfunction after liver transplantation.
CTP Donor & Recipient Evaluation 5
Which laboratory finding in a potential pancreas donor is considered the most concerning for pre-existing pancreatic dysfunction?