Allocation Flashcards by Jessica Johnson

Lung allocation score (LAS)

The scoring system used to measure illness severity in the allocation of lungs to candidates 12 years and older

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Match run

A process that filters and ranks waiting list candidates based on deceased or non-directed living donor and candidate medical compatibility and organ-specific allocation criteria.

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Model for End Stage Liver Disease (MELD)

The scoring system used to measure illness severity in the allocation of livers to adults.
Reflects the probability of death within a 3-month period
maximum MELD score is 40

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Antigen mismatch

An antigen mismatch occurs when an identified deceased or living donor antigen is not recognized as equivalent to the recipient’s own antigens. In cases where a donor or candidate only has one antigen identified at a human leukocyte antigen (HLA) locus (A, B, or DR), the antigens are considered to be identical at that locus.

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Pediatric End Stage Liver Disease (PELD)

The scoring system used to measure illness severity in the allocation of livers to pediatric candidates.
Reflects the probability of death within a 3-month period

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Potential transplant recipient (PTR)

A candidate who appears on a match run.

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Qualified specimen

A blood specimen without evidence of hemodilution

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Unacceptable antigens

Antigens to which the patient is sensitized and would preclude transplantation with a deceased or living donor having any one of those antigens.

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Zero antigen mismatch
zero mismatch or
0-ABDR mismatch

A candidate is considered a zero antigen mismatch with a deceased or living donor if all of the following conditions are met:
1. At least one donor antigen is identified for each of the A, B, and DR loci
2. At least one candidate antigen is identified for each of the A, B, and DR loci
3. The donor has zero non-equivalent A, B, or DR antigens with the candidate’s antigens
4. The donor and the candidate have compatible or permissible blood types
In cases where a candidate or donor has only one antigen identified at an HLA locus (A, B, or DR), the antigens are considered to be identical at that locus.

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Zone A

Includes all transplant hospitals within 500 nautical miles of the donor hospital but outside of the donor hospital’s DSA.

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Zone B

All transplant hospitals within 1,000 nautical miles of the donor hospital but outside of Zone A and the donor hospital’s DSA.

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Zone C

All transplant hospitals within 1,500 nautical miles of the donor hospital but outside of Zone B and the donor hospital’s DSA.

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Zone D

All transplant hospitals within 2,500 nautical miles of the donor hospital but outside of Zone C.

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Zone E

All transplant hospitals MORE than 2,500 nautical miles from the donor hospital.

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When can a heart be allocated out of sequence?

Sensitized candidates within DSA
1. The candidate’s transplant surgeon determines
the candidate’s antibodies would react adversely to certain human leukocyte antigens (HLA).
2. All heart transplant programs and the OPO within the DSA agree to allocate a heart from a compatible deceased donor to the sensitized candidate.
3. The candidate’s transplant program, all heart transplant programs, and the OPO within the DSA AGREE upon the level of sensitization at which a candidate qualifies for the sensitization exception.

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Heart- Lung Allocation Guidelines

When a heart-lung candidate is allocated a HEART, the lung from the same donor MUST be allocated to the heart-lung candidate.
When the heart-lung candidate is allocated a LUNG, the heart from the same donor may only be allocated to the heart-lung candidate if no Status 1A isolated heart candidates are eligible to receive the heart.

Calculated Panel Reactive Antibody (CPRA)

percentage of donors expected to have one or more of a candidate’s indicated unacceptable antigens.

Kidney Donor Profile Index (KDPI)

How Donor Kidneys are classified. The KDPI score is derived directly from the Kidney Donor Risk Index (KDRI) score. The KDPI is the percentage of donors in the reference population that have a KDRI less than or equal to this donor’s KDRI.

Donor criteria used to calculate KDRI (10)

Age
Ethnicity
Creatinine
Hx of HTN
HX of DM
Donors with CVA COD
Height
Weight
DCD Donor
HCV status

Blood Type O

donors allocate to

Universal Donor

Priority given to O

Blood Type A

donors allocate to

Blood type A

Blood type AB.

Blood Type B

donors allocate to

Blood type B.

Blood Type AB

donors allocate to

Blood type AB.

Blood Types A, non-A1 and AB, non-A1B

donors allocate to

Blood type B

Sometimes Blood type O

What must happen before Double Kidney Allocation takes place?

OPO must offer kidneys individually through one of the allocation sequences before offering both kidneys to a single candidate unless donor meets Double Kidney Allocation criteria

Double Kidney Allocation criteria (5)

- Age >60 yo - Estimated creatinine clearance is less than 65 mL/min on admission - Rising serum creatinine (greater than 2.5 mg/dL) at time of organ recovery - Hx of longstanding htn or dm - Glomerulosclerosis greater than 15% and less than 50%

Choice of Right versus Left Kidney

the transplant hospital that received the offer for the candidate with higher priority on the waiting list will have choice

Who Makes National Kidney Offers?

UNOS

Criteria to split Liver (4)

1. Less than 40-years old 2. On a single vasopressor or less 3. Transaminases no greater than three times the normal level 4. Body mass index (BMI) of 28 or less

Transplant centers have how long to review and acknowledge and offer

1 HOUR

Blood type O. | Kidneys are allocated to

Blood type O. For offers made to candidates in 0-ABDR mismatch categories, blood type O kidneys may be transplanted into candidates who have blood types other than O.

Blood Type B | Kidneys are allocated to

Blood type B. For offers made to candidates in 0-ABDR mismatch categories, blood type B kidneys may be transplanted into candidates who have blood types other than B.

What transportation is the host OPO responsible for ensuring?

The host OPO is responsible for determining that non-local procurement teams have transportation to and from the local airport.

Who is responsible for all transportation costs associated with deceased donor kidneys ((isolated) and tissue typing materials?

OPO If deceased donor kidneys, and associated tissue typing materials are shipped without any other organs, then the host OPO is responsible for all transportation

Who is responsible for all transportation costs associated with all non-renal organs and tissue typing materials from deceased or living donors?

transportation costs are the responsibility of the RECIPIENT/transplant center receiving the organ. If an organ or tissue typing material is forwarded to another PTR for any reason the RECIPIENT/transplant center that finally receives the organ or tissue typing material is responsible for transportation costs;