Management Flashcards
OPTN Policy 2
What donor documentation is submitted to UNOS to enable complete and accurate evaluation of donor suitability by transplant programs?
((What (9) items must be uploaded to Donornet?))
a. ABO
b. ABO subtype
c. IDT
d. Death pronouncement
e. Authorization for donation
f. HLA
g. Donor evaluation and management
h. Donor medical and behavioral history (UDRAI)
i. Organ intraoperative findings
OPTN Contractor
UNOS
OPO must perform these 4 things & report the resulting information to all receiving OPOs or transplant hospitals:
- Attempt to obtain the deceased donor’s medical and behavioral history from one or more individuals familiar with the donor ( UDRAI )
- Review the deceased donor’s medical record.
- Complete a physical examination of the deceased donor, including the donor’s vital signs.
- Document in the deceased donor medical record if any of this information is not available and the reason it is not available.
UDRAI for each potential deceased donor must include all of the following 3 things
- Any testing used to identify the presence of transmissible diseases or malignancies or any other known condition that may be transmitted by the deceased donor organ and may reasonably impact the recipient.
- Whether the potential deceased donor has factors associated with an increased risk for disease transmission, including blood-borne pathogens.
- Whether the potential deceased donor has a history of prior exposure or treatment with nonrecombinant Human Pituitary Derived Growth Hormone (HPDGH). If so, the potential deceased donor has an increased risk of prion disease and the host OPO must communicate this information to all transplant programs receiving organs from the donor.
PHS Increased Risk
If the deceased donor meets the criteria for increased risk for HIV, Hepatitis B, and Hepatitis C transmission set forth in the current U.S. Public Health Services (PHS) Guideline or the host OPO cannot obtain the information necessary to make this determination, the host OPO must identify the donor as having increased risk for transmission of HIV, Hepatitis B, and Hepatitis C and communicate this information to all transplant programs receiving organs from the deceased donor.
What blood samples for deceased donor serological screening should be used?
OPOs must use qualified (non-hemodiluted) blood samples. If a qualified sample is not available for testing, a hemodiluted sample may be used for deceased donor screening tests.
What must you do if you use hemodiluted/ non qualified blood samples for serological screening?
PHS Increased Risk
OPO must treat the deceased donor as presenting an increased risk for disease transmission
Hemodilution proof:
OPO must document in the deceased donor medical record a complete history of-
All blood products and intravenous fluid transfusions the deceased donor received since admission to the donor hospital.
OPO must assess all potential deceased donor blood samples obtained for serological screening tests using what method?
Hemodilution using a U.S. Food and Drug Administration (FDA) approved hemodilution calculation.
Deceased Donor Blood Type Determination Requirements(4)
- Be drawn on two separate occasions (minimum 5min apart)
- Have different collection times
- Be submitted as separate samples
- Have results indicating the same blood type
What ABO requires subtyping?
A
host OPO must document either that subtyping was completed or the reason it could not be completed.
What ABO is subtyping optional?
AB
Requirements for subtyping (4)
-
1. Be tested on PRE PRBC transfusion samples*
2. Be drawn on two separate occasions
3. Have different collection times
4. Be submitted as separate samples
What must you do if you receive conflicting subtype results?
Subtype results must NOT BE REPORTED to UNOS
Allocate based off primary blood type.
The deceased donor is not eligible for a match run until the host OPO completes ABO verification and reporting as follows:
-Two different qualified health care professionals, must each make an independent report of the donor’s blood type as well as subtype (if applicable) to UNOS.
- Both qualified health care professionals must use all blood type and subtype determination source documents to verify they:
a. Contain blood type and subtype results for the donor
b. Indicate the SAME blood type and subtype on the two test results
c. Match the result reported to UNOS
Required Deceased Donor General Risk Assessment
7
- Arterial blood gas results
- Blood type
- Chest x-ray
- CBC
- Electrolytes
- Serum glucose
- Urinalysis, within 24 hours before cross clamp
- Blood and urine cultures
Required Deceased Donor Infectious Disease Testing (7)
1- HIV 2- Hepatitis B 3- Hepatitis C 4- Cytomegalovirus (CMV) 5- Epstein-Barr Virus (EBV) 6- Syphilis (RPR) 7- Toxoplasma
All tests results must be reported to all recipient transplant hospitals
ASAP but no later than 24 hours after receiving the test result.
Required OR info for Deceased Kidney Donors (6)
- Intra op Kidney anatomy - including number of blood vessels, ureters, and approximate length of each
- Injuries to or abnormalities
- Anesthesia Record (Recovery blood pressure and urine output information; 17. Recovery medications)
- Type of recovery procedure,
flush solution and method, and flush storage solution - Warm ischemia time and organ flush characteristics
Required LABS for Deceased Kidney Donors (4)
- HLA information
- Assurance that final blood and urine cultures are pending
- Final urinalysis
- Final blood urea nitrogen (BUN) and creatinine
Required INFO for Deceased Kidney Donors (9)
- Donor name
- Donor ID
- Date of admission for the current hospitalization
- Ethnicity
- Relevant past medical or social history
- Current history of abdominal injuries and operations
- Current history of average blood pressure, hypotensive episodes, average urine output, and oliguria
- Current medication and transfusion history
- Indications of sepsis
Required INFO for Deceased Liver Donors
- Donor name & 2. UNOS ID
- Ethnicity
- Height & 5. Weight
- Vital signs
- Social history, including drug use
- HPI in hospital including current medications, vasopressors, and hydration
- Current history of hypotensive episodes, urine output, and oliguria
- Indications of sepsis
Required LABS for Deceased Liver Donors
- Aspartate aminotransferase (AST)
- Bilirubin (direct)
- Other laboratory tests within the past 12 hours including:
- Human leukocyte antigen (HLA) typing
Required INFO for Deceased Heart Donors
- Height & 2. Weight
- Vital signs
- HPI w/ treatment in hospital including vasopressors and hydration
- Cardiopulmonary, social, and drug activity histories
- Details of any documented cardiac arrest or hypotensive episodes