Medical and Behavioral History

Question 1

In 1994 which government agency created a mandate for change in an attempt to prevent the transmission of HIV through transplantable organs and tissues?

Answer 1

United States Public Health Service (USPHS)

Question 2

The 1987 revision of the Uniform Anatomical Gift Act (UAGA) clarified that:

Answer 2

An individual’s donation of his or her organs and/or tissues cannot be overriden by their next of kin

Question 3

How can the interviewer determine if he/she is speaking with the best historian for the medical behavioral interview?

Answer 3

The best historial is the person who has the most recent and intimate knowledge of the potential donor.

Question 4

In setting the stage for the medical behavioral interview, the historian should be informed of which of the following?

• -The historian only has to answer the questions that they want to
• -Risk factors for HIV infection, emphasizing that HIV can be transmitted via transplanted organs and tissues
• -The information will be shared with anyone who inquires

Answer 4

Risk factors for HIV infection, emphasizing that HIV can be transmitted via transplanted organs and tissues

Question 5

Your donor is four months old. What is the procedure for completing the medical behavioral history interview?

Answer 5

Complete a separate questionnaire for the baby, mother, and if possible, the father.

Question 6

A recipient of dura mater is excluded as a potential tissue donor due to it’s association with what disease?

Answer 6

Creutzfeldt-Jakob Disease

Question 7

A local hospital calls you with the referral of a 36 year old man as a potential organ and tissue donor. They share with you that his parents are deceased; he is not married and has no children. His next of kin are his two sisters. During the consent conversation, the younger sister informs you that she wants to move forward with donation, but she does not want you to talk to her older sister, as she will never agree. You would:

• -Agree to recover only those tissues that will leave no evidence that donation has occurred.
• -Move forward with the donation as you have one sibling who wants to donate.
• -Talk to the younger sister and share with her that both she and her sister must be in agreement for donation to move forward.

Answer 7

Talk to the younger sister and share with her that both she and her sister must be in agreement for donation to move forward.

Question 8

If the historian answers “yes” to one of the exclusionary criteria, often referred to as the high risk questions on the medical behavioral history questionnaire, what should the interviewer do?

Answer 8

Inform all transplant professionals involved in organ assessment.

Question 9

What is the correct order of next of kin (NOK) priority when obtaining consent for organ and tissue donation?

Answer 9

Spouse
Adult child
Parent
Adult sibling

Question 10

In setting the stage for the medical behavioral interview, it is important to explain to the historian that:

• -They are the best historian if they know any of the answers
• -The interview will only take a few minutes
• -There are about 40 questions and we will need to ask each one.

Answer 10

There are about 40 questions and we will need to ask each one.

Question 11

How should the next of kin (NOK) or significant life partner (SLP) be interviewed?

Answer 11

In a confidential and sensitive manner by a health-care professional competent to elicit information about behaviors that place persons at a high risk for HIV.

Question 12

What should the interviewer do if the historian does not understand the question that is being asked?

Answer 12

Re-phrase the question in words that the historian can understand

Question 13

You receive a call from a local hospital with a referral of a 17 year old that has a donor indication on his driver’s license. In order to proceed with donation, you must:

Answer 13

Obtain legal consent from his next of kin

Question 14

Undue pressure to donate may encourage the next of kin (NOK) or significant life partner (SLP) to do which of the following?

Answer 14

Minimize the accuracy of the information related to a donor’s behaviors that put him/her at high risk for HIV transmission.

Question 15

What is the purpose of the high risk questions asked during the medical behavioral history?

Answer 15

Identify behaviors that place an individual at risk for HIV

Question 16

Close contact with an individual with Severe Acute Respiratory Syndrome (SARS), is defined as:

Answer 16

Having cared for or lived with someone with SARS or having direct contact with respiratory secretions or bodily fluids of a patient with SARS.

Question 17

Informed consent for a deceased donor should contain the following information about the person giving consent:

• -The identity and relationship of the Consenting Person, including the name, address and telephone number.
• -Name, address, and phone number of the potential donor.
• -Name of potential donor, hospital, date and time of death.

Answer 17

The identity and relationship of the Consenting Person, including the name, address and telephone number

Question 18

Unexplained blue or purple spots on the skin and/or mucous membranes, unexplained lymphadenopathy lasting greater than 1 month, and unexplained weight loss may be evidence of what infection?

• -HIV
• -Hepatitis C
• -Thrombocytopenia Pupura

Answer 18

HIV

Question 19

When interviewing a historian, which of the following should you do?

• -Refer to the potential donor as ‘the deceased’
• -Never use the potential donor’s name
• -Replace ‘deceased’ with the potential donor’s name or relationship (i.e. wife, etc)

Answer 19

Replace ‘deceased’ with the potential donor’s name or relationship (i.e. wife, etc)

Question 20

If the historian has answered a question with ‘I don’t know’, what should the interviewer do?

• -Ask the historian to answer to the best of their knowledge.
• -Leave the answer blank
• -Do nothing, the answer is good enough

Answer 20

Ask the historian to answer to the best of their knowledge.

Question 21

Which of the following scenarios would place an individual at high risk for HIV transmission if they were an organ donor?

• -An inmate of a correctional system or jail
• -A 2 yr old who has not been breast-fed in the last 12 months, whose mother is at risk for HIV
• -A man who has had sex with a woman in the previous 12 months

Answer 21

An inmate of a correctional system or jail

Question 22

Which of the following scenarios would place an individual at high risk for HIV transmission if they were an organ donor?

• -A nurse who was exposed to HIV infected blood through an accidental needle stick 4 yrs ago.
• -A man who has had sex in exchange for money or drugs in the last 3 years
• -A hemophiliac who has received non-human derived clotting factor concentrates.

Answer 22

A man who has had sex in exchange for money or drugs in the last 3 years

Question 23

What should the interviewer do if unable to conduct a medical behavioral interview on a potential donor?

–Rule out the donor
–Inform the transplant surgeon that the OPO will pursue the donation even though an interview with an appropriate historian could not be obtained
Nothing, the serology testing and physical exam will provide the necessary information

Answer 23

Inform the transplant surgeon that the OPO will pursue the donation even though an interview with an appropriate historian could not be obtained

Question 24

Which of the following three screening components ensure the safety of organs for transplant and minimize the risk of disease transmission?

• -Serological testing, plasma dilution assessment, nurse interview
• -Physician interview, chart review, physical assessment
• -Medical behavioral interview, physical assessment, serologic testing

Answer 24

Medical behavioral interview, physical assessment, serologic testing

Question 25

A potential donor is divorced and has an adult son who is disabled and lives in a group home. The mother of the donor states that her grandson is not competent to make decisions. In order to proceed with donation you would need to do what first?

Answer 25

Determine if a court of law had deemed the son to be incompetent to make decisions

Question 26

In the Morbidity and Mortality Weekly Report issued in October 1994, what is one of the differences between infectious disease and screening of an organ donor versus a tissue donor?

Answer 26

Organs are limited to life-saving, whereas tissues are life-enhancing

Question 27

When completing the medical behavioral interview, the interviewer should do which of the following?

• -Don’t ask the high risk questions if the donor is a child.
• -Ask every question, the same way, every time.
• -Ask only the questions that are pertinent to the potential donor

Answer 27

Ask every question, the same way, every time