Definitions/acronyms/miscellaneous Flashcards
Allocation MELD or PELD score
The highest exception or MELD or PELD score, including liver-intestine points, available to the candidate at the time of a match run for a liver or liver-intestine
Alternative allocation system
A type of variance that allows members who are permitted to join the variance to allocate organs differently than the OPTN policies.
Alternative local unit (ALU)
A type of variance that creates a distinct geographic area for organ procurement and distribution
Alternative point assignment system
A type of variance that allows members who are permitted to join the variance to assign points for organ allocation differently than required by the OPTN policies
Antigen mismatch
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 locus (HLA locus) (A, B, or DR) the antigens are considered to be identical at that locus.)
Approved MELD or PELD exception
A MELD or PELD exception or exception extension that met standardized criteria in OPTN policy or was reviewed and approved by the NLRB
Assigned MELD or PELD exception
A MELD or PELD exception or exception extension where the NLRB failed to make a decision within 21 days of the request submission and the candidate was assigned the requested score.
Bridge donor
A kidney paired donation (KPD) donor who does not have a match identified during the same match run as the donor’s paired candidate and continues a chain in a future match run.
Calculated MELD or PELD score
The highest non-exception MELD or PELD score available to the candidate according to policy. EXCLUDES LIVER-INTESTINE POINTS.
Calculated panel reactive antibody (CPRA)
The percentage of deceased donors expected to have 1 or more of the unacceptable antigens indicated on the waiting list for the candidate. The CPRA is derived from HLA antigen/allele groups and halotype frequencies for different ethnic groups in proportion to their representation in the national deceased donor population.
Chain
A set of KPD matches that begins with a donation from a non directed living donor to that KPD donor’s matched candidate. This candidate’s paired living donor then donates to the KPD donor’s matched candidate. A chain continues until a living donor donates to an orphan candidate, a waiting list candidate, or is a bridge donor.
Covered VCAs
Covered vascularized composite allograft body parts
Covered VCAs of the upper limb
Any group of vascularized body parts from the upper limb
Covered VCAs of the head and neck
Face, Larynx , vascularized parathyroid gland, scalp, trachea, vascularized thyroid, and any other vascularized body parts from the head neck
Covered VCAs of the abdominal wall
Abdominal wall, synthesis pubis, and any group of vascularized skeletal elements of the pelvis
Covered VCAs of the genitourinary organ
Uterus, internal and external male and female genitalia, and urinary bladder
Covered VCAs (vascularized glands)
Adrenals and thymus
Covered VCAs of the lower limb
Pelvic structures that are attached to the lower limb and transplanted intact, gluteal region, vascularized bone transfers from the lower extremity, Toe transfers, and any group of vascularized body parts from the lower limb
Covered VCAs (musculoskeletal composite graft segment)
Spine axis, chest wall, and other composite graft of vascularized muscle, bone, nerve, or skin
Covered VCAs (spleen)
The spleen is also a covered VCA listed separately from other regions of the body.
Domino donor
An individual who has an organ removed as a component of medical treatment and who receives a replacement organ. The organ that was removed is transplanted into another person.
Donation after circulatory death (DCD)
the organ recovery process that may occur following death by irreversible cessation of circulatory and respiratory functions. A DCD donor may also be called a non-heartbeating, asystolic, or donation after cardiac death donor
Donation Service Area (DSA)
The geographic area designated by the Centers for Medicare and Medicaid Services (CMS) that is served by one organ procurement organization, 1 or more transplant hospitals, and 1 or more donor hospitals
Standards of eligible death
Is 75 years old or less, Is legally declared dead by neurologic criteria according to state or local law, Has body weight of five kg are greater, Has a body mass index of 50kg/m² or less, Has at least one kidney, liver, heart, or lung that meets eligibility standards
Criteria that would render the kidney ineligible:
Greater than 70 years old, Age 50-69 years with history of type one diabetes for more than 20 years, Polycystic kidney disease, Glomerulosclerosis 20%+ by kidney biopsy, Terminal serum creatinine greater than 4mg/dL, Chronic renal failure, No urine output for 24+ hours
Criteria that would render the liver ineligible:
Cirrhosis, Terminal total bilirubin greater than or equal to 4mg/dL, Portal hypertension, Macrosteatosis 50%+ or fibrosis greater than or equal to stage 2, Fulminant hepatic failure, Terminal AST/ALT greater than 700 U/L
Criteria that would render the heart ineligible:
Greater than 60 years old, 45 years older older with a history of 10 or more years of HTN or 10 or more years of type 1 diabetes, history of coronary artery bypass graft (CABG), History of coronary stent/intervention, current or past medical history of MI, severe vessel diagnosis as supported by cardiac catheterization (50%+ occlusion or 2+ vessel disease), Acute myocarditis and/or endocarditis, Heart failure due to cardiomyopathy, Internal defibrillator or pacemaker, Moderate to severe single valve or 2-valve disease documented by echo or cardiac catheterization or previous valve repair, Serial echo results showing severe global hypokinesis, Myxoma, Congenital defects (surgically corrected or not)
Criteria that would render the lung ineligible:
Greater than 65 years old, Diagnosed with COPD, Terminal PaO²/FiO² less than 250 mmHg, Asthma (with daily prescription), Asthma as a cause of death, Pulmonary fibrosis, Previous lobectomy, Multiple blebs documented on CAT scan, Pneumonia indicated on CT scan x-ray bronchoscopy or cultures, Bilateral severe pulmonary contusions on CT scan
Criteria that would render an otherwise eligible death ineligible:
Any of the following infections: bacterial (tuberculosis, gangrenous or perforated bowel, intra-abdominal sepsis), viral (rabies, reactive hep-B surface antigen, retrovirals such as encephalitis or meningitis, active herpes simplex, varicella zoster (chickenpox or shingles), cytomegaloviruses or pneumonia, acute epstein-barr virus (mononucleosis), West Nile virus, SARS, or HIV) (HIV-POSITIVE ORGANS CAN STILL BE PROCURED FOR TRANSPLANTATION INTO AN HIV-POSITIVE RECIPIENT ACCORDING TO POLICY 15.7 AS AN OPEN VARIANCE), fungal (cryptococcus, aspergillus, histoplasma, coccidioides, active candidemia or invasive yeast infection), parasites (active infection with trypanosoma cruzi (chaga’s), leishmania, strongyloides, or malaria), or prions (creutzfeldt-jacob disease)
General exclusions to eligibility
Aplastic anemia, Agranulocytosis, Current malignant neoplasms (except non-melanoma skin cancers and primary CNS tumors without evident metastatic disease), Previous malignant neoplasms with current metastatic evidence, History of melanoma, Hematologic malignancies (leukemia, Hodgkins disease, lymphoma, multiple myeloma), Active bacterial viral fungal or parasitic meningitis or encephalitis, No discernable cause of death
Intended incompatible
Donor and candidate primary blood types that are biologically incompatible, but transplantation is permissible according to policy
Lower respiratory specimen
A sample taken from the respiratory system within the trachea or below.
Examples: sputum, tracheal aspirate, bronchial suction, bronchial wash, bronchalveolar lavage (BAL), lung biopsy
Open variance
A variance that allows members other than the members that applied for it the option to join
Orphan candidate
A KPD candidate who does not receive a kidney transplant from the matched donor for any reason after the candidate’s paired donor has donated.
Criteria of a VCA
It is vascularized and requires blood flow by surgical connection of blood vessels to function, Containing multiple tissue types, Recovered from a human donor as an anatomical/structural unit, Transplanted into a human recipient as an anatomical/structural unit, Minimally manipulated, For homologous use (serves same function in recipient as it did in the donor), Not combined with another article/device, Susceptible to ischemia and thus stored temporarily (not cryopreserved), Susceptible to allograft rejection (often requiring immunosuppression)
Acceptable forms of variance
Alternative allocation systems, alternative local units, sharing arrangements, Alternative point assignment systems
Principles of all variances
- Variances must comply with NOTA and the final rule, 2. Members participating in a variance must follow all rules and requirements of the OPTN policies and bylaws, 3. if the board later amends an OPTN policy to contradict with the variance the policy amendment will not affect the existing variance, 4. If a member’s application to create amend or join a variance will require other members to join the variance the applicant must solicit their support, 5. The Board of directors may extend amend or terminate a variance at any time
Applications for a variance must include:
- The purpose for the proposed variance and how the variance will further this purpose, 2. Affirmative support from at least 75% of the members required to join the proposed variance if the variance requires other members, 3. A defined expiration date or period of time when the variance will end, the participating members will report results, and the sponsoring committee will evaluate the impact of the variance. 4. An evaluation plan with objective criteria to measure the variance’s success achieving the variance’s stated purpose. 5. Any anticipated difficulties in demonstrating whether the variance is achieving its stated purpose. 6. Whether this is an open variance or closed variance, and if this is an open variance any additional conditions for members to join this variance.
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