Organ Placement Flashcards
For an islet cell transplant to be most successful, 500,000 to 1.3 million donated islets of Langerhans, or islet cells must be transplanted. The islets of Langerhans consist of three types of cells. Which type should be transplanted?
- alpha cells
- delta cells
- beta cells
Beta cells
Beta cells produce insulin
On a lung match run, the potential recipients are listed in priority based on their Lung Allocation Score (LAS). Which of the following factors are not considered by the transplant center in determining the LAS?
- Age
- Creatinine
- Smoking status
Smoking status
A 17 year old male has been admitted to the ICU after a MVA. Injuries include a SDH and bilateral rib fxs. Chest tubes have been placed for bilateral pnemothoraces. He had no downtime. He has been declared braindead and consent has been obtained for organ donation. Medical/behavioral Hx includes IDDM since age 2 yrs, once-weekly marijuana use, and consumption of a 12-pack of beer on the weekends. Labs reveal: Amylase 300, Lipase 20, Total CPK 3100, CPK-MB 11, Troponin-I 4.3, EKG shows slight ST elevation. What should the procurement coordinator suspect?
- Acute MI
- Cardiac contusion
- Facial fractures
Cardiac contusion
What antigen is found in blood type O?
None
An EKG is done, and the donor is noted to have EKG changes in leads II, III, aVF. What do you suspect based on these changes?
- anterior wall MI
- lateral wall MI
- inferior wall MI
Inferior wall MI
Which of the following statements regarding lung placement is true?
- -Sputum gram stain must be completed prior to lung offer
- -ABG results must be done within 2hrs prior to lung offer
- -CXR must be taken and interpreted by a physician within 6hrs prior to lung offer
Sputum gram stain must be obtained prior to lung offer
HLA (Human Leukocyte Antigen) and PRA (Panel Reactive Antibody) testing is completed for which organ(s) and why is testing completed?
- -HLA testing either includes or excludes a particular recipient and a particular donor for a kidney transplant match. PRA testing is then used to confirm that the kidney transplant will be successful, dtermined by the level of antibody interaction/reaction.
- -PRA testing is completed on a regular basis to determine the level at which a recipient’s immune system will accept or reject renal and non-renal organs. The results of the PRA then help to identify and eliminate potential recipients. The final HLA testing identifies the final donor/recipient match.
- -HLA testing identifies a potential match between donor and recipient for kidney and pancreas placement. The PRA is used to verify that the donor and recipient antigens and antibodies are minimally reactive.
HLA testing identifies a potential match between donor and recipient for kidney and pancreas placement. The PRA is used to verify that the donor and recipient antigens and antibodies are minimally reactive.
The A subgroup is most important when placing which of the following organs?
- -Heart
- -Liver
- -Kidney
Liver
Because an A2 –non A1– donor can also give to an O recipient
When assessing pancreatic function, what lab value is more reliable or sensitive?
- -Amylase
- -Glucose
- -Lipase
Lipase
A 17yr old male has been admitted to the ICU after a MVA. Injuries inclued a SDH and bilateral rib fxs. Chest tubes have been placed for bilateral pnemothoraces. He has been declared brain dead and consent has been obtained for organ donation. Medical/behavioral history includes IDDM since the age of 2, once-weekly marijuana use, and consumption of a 12-pack of beer on the weekends. Based on the donor profile, which organs should the procurement coordinator evaluate for donation?
- -Heart, lungs, liver, kidneys, intestine
- -Heart, lungs, liver, kidneys, pancreas, intestine
- -Heart, liver, kidneys, intestine
Heart, lungs, liver, kidneys, intestine
all but pancreas because of the IDDM since age 2
When evaluating renal function based on laboratory values, which statement is most accurate?
- -The BUN test is primarily used to evaluate kidney function under a wide range of circumstances, including acute or chronic kidney dysfunction or failure
- -BUN and serum creatinine tests are best interpreted together, comparing the two results, to correctly assess renal function
- -Serum creatinine is the only true assessment tool of renal function
BUN and serum creatinine tests are best interpreted together, comparing the two results, to correctly assess renal function.
In which of the following case scenarios are the lungs most likely to be placed after aggressively managing the donor?
- -A 25yr old female, in the hospital for three days whose CXR shows bilateral atelectasis. Initial O2 challenge shows a PO2 of 180.
- -A 25yr old female in the hospital for one week, bronch shows bilateral thick, yellow secretions. Initial O2 challenge shows a PO2 of 280.
- -A 25yr old female in the hospital for 12hrs. Admission CT shows bilateral pulmonary contusions. Initial O2 challenge shows a PO2 of 330.
A 25yr old female, in the hospital for three days whose CXR shows bilateral atelectasis. Initial O2 challenge shows a PO2 of 180.
Your donor is a 39yr old female who has type 1 diabetes mellitus and has smoked two packs a day for the last 20yrs. This donor should have:
- -A balloon pump
- -A swan-ganz catheter
- -A cardiac catheterization
Cardiac Cath
Which two PRA levels are listed when a UNOS list of potential kidney recipients is run?
- -The highest and most recent
- -The highest and lowest
- -The lowest and most recent
Highest and most recent
In a donor with hypergylcemia, what additional testing should be performed to evaluate the donor’s pancreas?
- -Amylase
- -GGT
- -HgbA1c
HgbA1c
A 44yr old male who suffered a self-inflicted GSW to the head has been declared brain dead. Consent has been obtained for organ donation. He is 6ft tall and weighs 100kg. His PMH is significant for a 10 pack-year smoking history and high cholesterol. His vitals signs are: HR 132, BP 90/60, CVP 1, SaO2 96%. After stabilizing the donor, the procurement coordinator decides to place a swan-ganz catheter to aid in heart evaluation. Which of the following might occur as a complication of a PAOP measurement?
- Pulmonary artery rupture
- Pulmonary artery embolus
- Thrombus formation
Pulmonary artery rupture
Which organ does not require HLA matching?
- -Liver
- -Heart
- -Pancreas
Liver
What test done at the bedside typically is used for evaluation of structural abnormalities, LV and RV function, LVEF and other measurements in the organ donor?
- -Dobutamine stress echo
- -Trans-esophageal Echocardiogram (TEE)
- -Trans-thoracic Echocardiogram (TTE)
TTE
When placing intestines, why is the CMV status of the donor particularly important?
- -Because the donor antibiotics prior to transplant, which will need to be continued for the recipient post-transplant.
- -Because the incidence of CMV disease is highest in a CMV-negative recipient who receives a CMV-positive intestine graft.
- -It is not important because the incidence of CMV transmission is not different than those found in patients with other solid-organ transplants.
Because the incidence of CMV disease is highest in a CMV-negative recipient who receives a CMV-positive intestine graft.
What is the most critical determinant of compatibility between donor and recipient organs for transplantation?
- -Rh factor
- -HLA typing
- -ABO grouping
ABO
What are the two antigen systems that have a considerable impact on transplantation identified on red blood cells and tissue cells?
- -The ABO system and the HLA system.
- -Antigen systems are not considered to have an impact on transplantation.
- -Only one system has a considerable impact: ABO
ABO and HLA
A 23 year old man presents to the ER after being involved in a MVA. He has massive facial fxs, a SDH, bilateral pulmonary contusions, and a stable pelvic fx. He has no significant PMH. He is 5’10” and weighs 70kg. As part of his trauma resuscitation, this donor received 10L of LR. What effects would the procurement coordinator expect as a result of this fluid resuscitation?
- -Improved lung compliance and decreased oxygen requirements.
- -Edema of the pancreas, intestine, and lungs.
- -Hypotension and decreased CVP.
Edema of the pancreas, intestine, and lungs.
Panel Reactive Antibody (PRA) is affected by which of the following?
- -The antigen composition of the cell panel and the HLA type of the patient.
- -The HLA type of the patient and the racial profile of the cell panel.
- -The antigen composition of the cell panel and the ABO type of the patient.
The antigen composition of the cell panel and the HLA type of the patient.
Which of the following best explains why a brochoscopy is needed for potential lung donors?
- -To provide information on anatomy, indicate if and where there is evidence of an infectious process, and provide opportunity to clear any mucous plugs that may be present.
- -To provide information on anatomy and to help prevent (or decrease already existing) pulmonary edema from occuring.
- -To provide information on anatomy and aggressively lavage any pus or blood from mucosal lining in order to prevent infection from occurring.
To provide information on anatomy, indicate if and where there is evidence of an infectious process, and provide opportunity to clear any mucous plugs that may be present.
This laboratory test is specific for cardiac injury
- -Troponin
- -CK-MB
- -Creatinine Kinase (CK)
Troponin
What blood types are identified in the ABO system?
A
B
AB
O
A donor’s urinalysis can and does provide relevant information that can be used in donor management. An important value calibrated in the urinalysis is the specific gravity, which is helpful in determining hydration status. What is normal specific gravity range from a single specimen?
Normal urine specific gravity may range from 1.002 to 1.030
HLA typing is used primarily for determining compatibility of which organ?
Kidney
If a person with blood type A has Anti-B present, what blood type may receive an organ from that person?
Recipients must be blood type A or AB
A 44yr old male who suffered a self-inflicted GSW to the head has been declared brain dead. Consent has been obtained for organ donation. He is 6ft tall and weighs 100kg. His PMH is significant for a 10 pack-year smoking history and high cholesterol. His vitals signs are: HR 132, BP 90/60, CVP 1, SaO2 96%. In order to evaluate the donor’s heart for transplantation, which of the following is the preferred IV line?
- -IJ catheter
- -Swan-ganz catheter
- -Central venous catheter
Swan-Ganz
A 44 year old male who suffered a self-inflicted GSW to the head has been declared brain dead. Consent has been obtained for organ donation. He is 6ft tall and weighs 100kg. His PMH is significant for a 10 pack-year smoking history and high cholesterol. Echocardiogram on this donor reveals an EF of 55%, trace MR, and no focal wall motion abnormalities. What action should the procurement coordinator take next?
- -Abandon heart placement
- -Start Dobutamine gtt
- -Arrange for cardiac cath
Arrange for a cardiac cath.
What factor determines whether or not there will be a reaction to the transplanted organ?
- -Antibodies in the donor
- -Antibodies in the recipient
- -Antibodies in the donor and the recipient
Antibodies in the recipient
In what blood types are Anti-A antibodies found?
Anti-A antibodies are found in those people who do not have the A antigen…
Blood types B and O
Which statement is true of small bowel transplant?
- -Small bowel transplant includes the transplantation of the liver, or multi-visceral organs
- -Small bowel transplant involves an interstitial allograft to an individual with irreversible intestinal failure.
- -Small bowel transplant has a five year survival rate of nearly 100% for intestinal transplant patients.
Small bowel transplant involves an interstitial allograft to an individual with irreversible intestinal failure.
What is the optimal number of antigens that can match between a donor and a potential recipient?
6
Is the rhesus (Rh) factor as much a concern in organ donation as it is in blood transfusion?
The Rh factor does not impact organ transplantation.
Which of the following donors should receive a cardiac cath?
- 52 yr old male
- 38 yr old male
- 42 yr old female
52 yr old male
Males over 40
Females over 45
Which of the following statements regarding lung placement is true?
- -Sputum gram stain must be obtained prior to lung offer
- -ABG results must be done within 2hrs prior to lung offers
- -Chest X-ray must be taken and interpreted by a physician within 6hrs prior to lung offer
Sputum gram stain must be obtained prior to lung offer
