Regulations and Policies

Question 1

Transportation costs to transport a non-renal organ to the destination of the accepting center are incurred by which member?

• -The recipient transplant center
• -The host OPO if the organ is used locally, the recipient transplant center if the organ is exported
• -The host OPO

Answer 1

The recipient transplant center

Question 2

When an OPO is offering a kidney for zero antigen mismatched candidates or for kidney and non-renal organ transplantation and the transplant center demands to choose which kidney they should receive, is the OPO required to comply?

• -No, the transplant center doesn’t have the implicit right to choose which kidney they receive.
• -Yes, the transplant center has the right to choose which kidney they receive, but only in cases where a liver/kidney is offered
• -Yes, the transplant center has the right to choose which kidney they receive

Answer 2

No, the transplant center doesn’t have the implicit right to choose which kidney they receive

Question 3

An OPO has completed organ shipping container labeling for a donor’s liver and kidney. A second OPO staff member reviews the labeling and initials the shipping container labels, verifying all the labels are correct. Does this meet the requirements of OPTN policy?

Answer 3

No, the OPO must retain documentation of the verification that the organ shipping container labels are correct. By initialing the label on the container that will travel to the accepting transplant center, the OPO is not retaining this documentation.

Question 4

An OPO’s advisory board has authority over which of the activities listed below?

• -Recommend policies concerning the appropriate tissue typing of organs
• -Recommend policies concerning the structure and by-laws of the OPO’s governing body.

Answer 4

Recommend policies concerning the appropriate tissue typing of organs

Question 5

What organ types are allowed by OPTN/UNOS policy to seek alternate recipients (“local backup”) in the event the organ cannot be transplanted into the intended candidate when shared regionally or nationally?

• -Kidney, Kidney/Pancreas, Pancreas
• -All abdominal organs
• -Heart, Lung, Liver

Answer 5

Kidney, Kidney/Pancreas, Pancreas

Question 6

A transplant center notifies local OPO of a medically urgent potential kidney recipient and requests special consideration in organ placement. The OPO bypasses potential recipients to allocate kidney to medically urgent recipient. How is the match run documented and UNOS notified of the allocation?

• -The OPO codes 860 (medical urgency of another potential recipient) for bypassed potential recipients with a textbox explanation and closes the match run to show allocation to the medically urgent recipient. The OPO refers the transplant center to the UNOS Organ Center in order to report medically urgent status of the recipient.
• -The OPO verifies that other local centers agreed to this allocation and codes 860 (medical urgency of another potential recipient) for the bypass of other potential recipients on the match run. The textbox field provided by the bypass code includes an explanation that other local centers agreed to the compassionate request. The transplant center submits a written verification of the potential recipient’s medical urgency.
• -The OPO codes 860 (medical urgency of another potential recipient) for the bypassed potentail recipients and in the textbox field provides a detailed explanation of the nature of the medical urgency for the recipient. The OPO verifies that other local centers agreed to this allocation.

Answer 6

The OPO verifies that other local centers agreed to this allocation and codes 860 (medical urgency of another potential recipient) for the bypass of other potential recipients on the match run. The textbox field provided by the bypass code includes an explanation that other local centers agreed to the compassionate request. The transplant center submits a written verification of the potential recipient’s medical urgency.

Question 7

OPOs must establish working relationships with hospitals in their service area. Which statement below most accurately describes one aspect of this working relationship?

• -OPOs should make available designated requestor training to hospital staff as the need arises
• -OPOs must train designated requestors on an annual basis
• -OPOs must offer to provide designated requestor training on at least an annual basis for hospital and critical access hospital staff

Answer 7

OPOs must offer to provide designated requestor training on at least an annual basis for hospital and critical access hospital staff

Question 8

A transplant center imports a kidney from an OPO outsides its DSA (National OPO). Because of the potential cold ischemic time, the host OPO grants “local back up” in case the intended recipient could not be transplanted. The transplant center admits the intended recipient to the hospital and discovers that he/she has an infection. Since the kidney cannot be used in the original intended candidate, alternate recipients should be sought by which member?

• -The transplant center selects another patient to be the actual recipient. Once the patient is selected the transplant center contacts its local OPO to inform the OPO of the change in actual recipient.
• -Since “local back up” is granted, the transplant center may select the next available patient within its center.
• -The OPO local to the importing center would then allocate the kidney in accordance with the local kidney match run.

Answer 8

The OPO local to the importing center would then allocate the kidney in accordance with the local kidney match run.

Question 9

Zero mismatched kidney offers from standard criteria donors are required to be shared by the Organ Center within how many hours of cross-clamp?

• -4 hours for SCD donors, 2 hours for ECD
• -8 hours for SCD donors, 4 hours for ECD
• -All zero mismatched kidneys must be offered pre-recovery.

Answer 9

8 hours for SCD donors, 4 hours for ECD

Question 10

An OPO may allocate double kidneys if the donor meets certain criteria set forth in OPTN Policy 3.5.7. Which of the following donors meets the criteria (creatinine clearance doesn’t apply)?

• -Donor is 70 yrs old, 3 yr hx of diabetes, and terminal Cr of 1.8
• -Donor is 61 yrs old, 5 yr hx of HTN, and glomerulosclerosis of 20%
• -Donor is 55 yrs old, 10 yr hx of HTN, and terminal Cr of 2.4

Answer 10

Donor is 61 yrs old, 5 yr hx of HTN, and glomerulosclerosis of 20%

Question 11

An OPO uses a wax coated, cardboard box with a rating of 32 pounds Edge Crush Strength for their organ shipping containers. Does this shipping container meet the requirements of OPTN policy?

• -No, OPTN policy requires that organ shipping containers have a strength rating of at least 200 pounds Burst Strength.
• -No, only reusable coolers are acceptable organ shipping containers.
• -Yes, the shipping container is wax coated and bears a strength certification stamp from the container’s manufacturer.

Answer 11

No, OPTN policy requires that organ shipping containers have a strength rating of at least 200 pounds Burst Strength.

Question 12

Which organs must be allocated through the UNOS Organ Center?

• -Zero mismatched kidneys, zero mismatched pancreas, zero mismatched kidney/panc, and renal paybacks.
• -Zero mismatched kidneys, zero mismatched pancreas, zero mismatched kidney/panc, renal paybacks, and all kidneys shared outside the local OPO area.
• -All kidneys and pancreas shared outside the local area

Answer 12

Zero mismatched kidneys, zero mismatched pancreas, zero mismatched kidney/panc, and renal paybacks.

Question 13

Donor lungs are recovered per standard en bloc procedure and each lung was packaged according to OPTN policy. During had off from back table to the Recovery Coordinator, the coordinator verified the organ type and side which was confirmed by the surgeon. The same process was repeated for the left lung. at the transplant hospital during the implant process, the lung packages were opened and it was discovered that the package labeled right lung was actually the left lung. The recipients were not harmed because the lungs were transplanted at the same recipient center. Is it mandatory for the recipient transplant center to notify UNOS of this occurrence?

• -No, reporting patient safety events to UNOS are voluntary.
• -Yes, OPTN policy requires that all patient safety events be reported to UNOS.
• -Yes, UNOS membership requires all patient safety events be reported to UNOS.

Answer 13

No, reporting patient safety events to UNOS are voluntary

Question 14

Under which donor clinical or logistical circumstances can the Organ Center make facilitated pancreas offers?

• -In the event that the Organ Center has attempted, but has been unable, to place the pancreas for a period of at least 5 hours, or upon notice to the Organ Center that organ retrieval is anticipated within 1 hour.
• -If the donor is greater than 50 years old or has a BMI greater than 30.
• -In the event that the pancreas has been offered to all local and regional pancreas candidates.

Answer 14

In the event that the Organ Center has attempted, but has been unable, to place the pancreas for a period of at least 5 hours, or upon notice to the Organ Center that organ retrieval is anticipated within 1 hour.

Question 15

During a multi-organ procurement, a visiting cardiac transplant team packages the donor heart using three sterile bags on a back table. The heart is labled and placed in a rolling cooler filled with ice. Is the heart properly packaged?

• -No, donor hearts must be packaged using 3 sterile barriers. In addition, the heart must be packed in a rigid container before the organ is placed in a cooler or organ shipping container for transport.
• -No, a cooler is not proper organ shipping container according to OPTN policy 5.5.
• -Yes, the three sterile bags will properly protect the donor heart during transport to the transplant center.

Answer 15

No, donor hearts must be packaged using 3 sterile barriers. In addition, the heart must be packed in a rigid container before the organ is placed in a cooler or organ shipping container for transport

Question 16

If the documented blood type of an organ shipped to a transplant center is inconsistent with the intended recipient’s blood type, which of the following steps must be taken?

• -No action is necessary. The transplant centers conduct their own blood typing upon receipt of the organ.
• -The recipient must be notified of the event. The transplant surgeon then determines the next course of action.
• -The OPO must conduct a thorough analysis of any adverse event and must use the analysis to affect changes in the OPO’s policies and practices to prevent repeat incidents.

Answer 16

The OPO must conduct a thorough analysis of any adverse event and must use the analysis to affect changes in the OPO’s policies and practices to prevent repeat incidents

Question 17

An OPO coordinator is paged overnight on a Friday by a transplant center that reports a recent kidney recipient has developed bacterial septicemia. The transplant center’s medical staff suspects that the donor could be the source of the infection. What is the appropriate course of action for the OPO coordinator to take?

• -Wait until all possible clinical information from the reporting transplant center is obtained and then call the UNOS organ center.
• -Wait until Monday morning to contact UNOS during business hours.
• -Contact the UNOS organ center by phone and report the incident through the potential disease transmission portal in UNet.

Answer 17

Contact the UNOS organ center by phone and report the incident through the potential disease transmission portal in UNet

Question 18

An OPO coordinator is placing organs from a 33 year old ABO “A” donor. When offering the liver to a local center, the surgeon indicates he would be interested in a kidney/pancreas for one of his patients. The OPO owes six payback “A” debts. Is it permissible for the host OPO to allocate one kidney to a local non-zero mismatched kidney/pancreas candidate and offer the other kidney out to satisfy a payback debt?

• -No. If six or more debts in the blood type of the donor are owed, the host OPO must offer both kidneys for payback prior to allocating one kidney to a non-zero mismatched kidney/panc candidate.
• -Yes. It is always permissible for an OPO to allocate one kidney locally for a kidney/panc candidate.
• -Yes, but only if the total number of kidney payback debts across all blood types is less than nine.

Answer 18

No. If six or more debts in the blood type of the donor are owed, the host OPO must offer both kidneys for payback prior to allocating one kidney to a non-zero mismatched kidney/panc candidate.

Question 19

OPOs must establish working relationships with hospitals in their service area. Which statement below most accurately describes one aspect of this working relationship?

• -An OPO must have a written agreement with all Medicare and Medicaid participating hospitals and critical access hospitals in its service area that have both a ventilator and an operating room and have not been granted a waiver by CMS to work with another OPO.
• -An OPO must have a written agreement with 95% of the Medicare and Medicaid participating hosptials in its service area that have an operating room and have not been granted a waiver by CMS to work with another OPO.
• -An OPO must have a written agreement with 95% of the the Medicare and Medicaid participating hospitals and critical access hospitals in its service area that have both a ventilator and an operating room and have not been granted a waiver by CMS to work with another OPO.

Answer 19

An OPO must have a written agreement with 95% of the the Medicare and Medicaid participating hospitals and critical access hospitals in its service area that have both a ventilator and an operating room and have not been granted a waiver by CMS to work with another OPO.

Question 20

An OPO sends vessels along with a liver to a transplant center. Should the OPO be notified of the outcome and/or use of the vessels?

• -No. The transplant center does not have to notify the OPO about the outcome and/or use of the vessels.
• -Yes. The transplant center does have to notify the OPO about the outcome and/or use of the vessels, but only if the vessels are stored for more than 14 days.
• -Yes. The transplant center must designate a person to monitor and maintain records and notify the OPO and OPTN of the outcome and/or use of the vessles.

Answer 20

Yes. The transplant center must designate a person to monitor and maintain records and notify the OPO and OPTN of the outcome and/or use of the vessels.

Question 21

An OPO coordinator is scrubbed at a back table packaging a liver for shipping. The coordinator packages the organ using three sterile bags and sterile ties. Care is taken to eliminate as much trapped air in each bag as possible. Before the organ can be placed in an organ shipping container, what information must be included on a label affixed to the outer bag?

• -UNOS ID, date of recovery, contents of bag
• -Donor ABO, date of recovery, cross clamp date and time
• -UNOS ID, donor ABO, contents of the bag

Answer 21

UNOS ID, donor ABO, contents of the bag

Question 22

You are working on a process improvement project with the goal of improving donor awareness. As part of the study, the group decides to invite transplant recipients to conduct an online survey. In order to increase participation, the OPO included a list of donor names on the site. Is this considered a breach of confidentiality?

• -If permission has been obtained from the donor families and the OPO’s medical director has given final approval, this is not considered a breach of confidentiality.
• -Research studies limited to donation are not considered a breach of confidentiality
• -If permission has not been obtained from the donor families, this is considered a breach of confidentiality.

Answer 22

If permission has not been obtained from the donor families, this is considered a breach of confidentiality.

Question 23

Kidneys from donors that do not meet the definition of an ECD, must be offered for zero mismatched patients (if applicable) by the UNOS organ center for what time period before the kidneys can be offered to local patients?

• -The organ center must offer to all zero mismatched candidates, regardless of the number of offers.
• -Kidneys from non-ECD donors must be offered for a minimum of 4 hours from the time the organ center makes the first offer.
• -Kidneys from non-ECD donors must be offered to a minimum of the first six candidates

Answer 23

Kidneys from non-ECD donors must be offered for a minimum of 4 hours from the time the organ center makes the first offer

Question 24

Which types of donors are not required to be offered to satisfy renal payback debts?

• -Kidneys from donors defined as DCD, or donors that are positive for Hep B Core Ab, or Hep C.
• -Kidneys from donors defined as an ECD, a DCD, less than 6 years old, or greater than 59 years old.
• -All kidneys are required to be offered to satisfy renal payback debts.

Answer 24

Kidneys from donors defined as an ECD, a DCD, less than 6 years old, or greater than 59 years old.

Question 25

Which of the following individuals may not be a member of an OPO’s advisory board?

• -An individual who represents the public in the OPO’s service area
• -A neurosurgeon who is a member of the OPO’s governing board
• -An organ donor family member

Answer 25

A neurosurgeon who is a member of the OPO’s governing board

Question 26

An OPO coordinator is managing a heart, liver, and kidney donor at a rural hospital in the OPO’s donor service area. After ordering a panel of liver function tests, the hospital’s laboratory notifies the OPO coordinator that a serum Gamma Glutamyl Transferase (GGT) test cannot be performed in its lab. After consultation with the OPO’s clinical manager, it is determined that sending a blood vacutainer to another lab is not possible. What is the appropriate course of action for this missing lab test?

• -Insert a serum GGT test result that the OPO coordinator believes accurately reflects common bile duct function based on other LFTs.
• -Leave areas in the donor record where serum GGT would be recorded blank to reflect that the test wasn’t done.
• -Document in the donor record the donor hospital’s inability to perform the test. Additionally, inform all coordinators or physicians receiving liver offers from this donor that the serum GGT cannot be performed.

Answer 26

Document in the donor record the donor hospital’s inability to perform the test. Additionally, inform all coordinators or physicians receiving liver offers from this donor that the serum GGT cannot be performed.

Question 27

If kidney payback debts are owed, how many payback offers are required to be made by the UNOS organ center before the organs can be placed locally?

• -The organ center must offer a minimum of six payback offers.
• -The organ center must offer to all OPOs with a payback credit, regardless of the number of offers.
• -The organ center must offer for a minimum of four hours

Answer 27

The organ center must offer a minimum of six payback offers.

Question 28

Expanded criteria donors are donors that meet which of the following criteria?

• -Greater than or equal to 60 years of age, or between 50 and 59 and meet at least two of the following three criteria: 1) CVA was the cause of death 2) hx of htn 3) a Cr greater than 1.5
• -Donors greater than 50 who meet at least three of the following four criteria: 1) CVA was the cause of death 2) hx of htn 3) a Cr greater than 1.5 4) donation after cardiac death
• -Donors greater than 50 who have any one of the following criteria: -Hx of HTN or diabetes, -Cr greater than 1.5, -donation after cardiac death, -renal bx shows greater than 15% glomerulosclerosis

Answer 28

Greater than or equal to 60 years of age, or between 50 and 59 and meet at least two of the following three criteria: 1) CVA was the cause of death 2) hx of htn 3) a Cr greater than 1.5

Question 29

OPOs must establish working relationships with hospitals in their service area. Which statement below most accurately describes the relationship between the hospital, OPO, and tissue banks?

• -OPOs do not have a responsibility to provide designated requestor training for tissue recovery. The tissue banks handle that responsibility.
• -OPOs must have arrangements to cooperate with all tissue banks in their service area.
• -OPOs must cooperate with tissue banks that have agreements with hospitals that the OPO has agreements with, and they must ensure that all useable tissues are obtained.

Answer 29

OPOs must cooperate with tissue banks that have agreements with hospitals that the OPO has agreements with, and they must ensure that all useable tissues are obtained.

Question 30

Transportation costs to transport a kidney to the primary destination of the accepting center are incurred by which member?

Answer 30

The Host OPO

ALWAYS

Question 31

Do OPTN/UNOS policies require HLA typing for Liver or Liver/intestine only donors?

Answer 31

No

Question 32

An OPO offers both kidneys to the UNOS organ center. The UNOS organ center places both kidneys in accordance with the kidney match run. The OPO then decides it wants to keep one kidney for a local kidney/pancreas patient so it withdraws the offer. The OPO also owes four paybacks to the UNet System at that time. Is this an OPTN policy violation?

• -No. Since the UNOS organ center placed the organs, the OPO has the right to withdraw the organs at anytime if a local patient becomes available for transplant.
• -Yes. If an organ is offered and accepted without conditions, the host OPO and recipient transplant center shall be bound by this transaction unless there is mutual agreement on an alternative allocation of the organ.
• -No. Since the OPO only owes four paybacks, it can keep the kidney for a local kidney/panc patient, even though the kidney has already been accepted for another patient.

Answer 32

Yes. If an organ is offered and accepted without conditions, the host OPO and recipient transplant center shall be bound by this transaction unless there is mutual agreement on an alternative allocation of the organ.

Question 33

OPOs must send complete documentation of the donor information to the transplant center with the organ. What action must occur prior to sending that documentation?

• -Two individuals, one of whom must be an OPO employee, will verify that the documentation is correct.
• -The medical director reviews all documentation prior to shipping the organ.
• -Each record must be electronically scanned prior to shipment.

Answer 33

Two individuals, one of whom must be an OPO employee, will verify that the documentation is correct.

Question 34

During the allocation process, a potential recipient of an organ offer does not appear on the match run due to any of the following: ECD, donor age/height/weight, inactive, not waitlisted when match run generated, HLA mismatches, or unacceptable antigens. What should be done?

• -Allocate the organ to the identified potential recipient
• -Update the candidate’s waitlist criteria and regenerate the organ match run to ensure that the actual recipient appears on a match run.
• -Send a letter to the UNOS department of evaluation and quality

Answer 34

Update the candidate’s waitlist criteria and regenerate the organ match run to ensure that the actual recipient appears on a match run.

Question 35

Following successful organ allocation and procurement, the OPO coordinator is notified by the transplant center that its intended liver recipient is no longer suitable for transplantation. This liver candidate appeeared at sequence number 35 on the match run list. What is the appropriate course of action regarding allocation of the liver?

• -Re-allocate the liver, starting at sequence number 36
• -Contact the host OPO’s local liver transplant program and place an “open offer” to their center.
• -Allow the transplant center who accepted the liver for candidate number 35 to have “local backup” and require the name of the new intended recipient prior to the charter aircraft’s departure.

Answer 35

Re-allocate the liver, starting at sequence number 36

Question 36

When an OPO sends organ and tissue typing material to another OPO or transplant center, should a tube of blood be sent for information purposes?

• -The procuring OPO can send any color top tube of blood to the transplant center
• -The procuring OPO only has to send a tube of blood to the importing OPO
• -Yes, but the tube of blood must be a red top tube. The red top tube is specifically for confirmation of ABO and must be sent to the receiving OPO or transplant center.

Answer 36

Yes, but the tube of blood must be a red top tube. The red top tube is specifically for confirmation of ABO and must be sent to the receiving OPO or transplant center

Question 37

It is required that OPOs have a written policy for specimen collection and storage established with laboratories approved by what organizations?

• -Each OPO only has to produce an internal written policy for specimen collection and storage and made available for OPTN/UNOS inspection.
• -OPOs are only required to have a written policy for specimen collection and it must be available for CMS inspection
• -Each OPO shall have a written policy for specimen collection and storage established with laboratories approved by the American Society for Histocompatibility and Immunogenetics (ASHI) or the OPTN.

Answer 37

Each OPO shall have a written policy for specimen collection and storage established with laboratories approved by the American Society for Histocompatibility and Immunogenetics (ASHI) or the OPTN.

Question 38

Does an OPO have to offer organs through the Match System once permission has been granted to procure all organs from a particular donor?

Answer 38

If an OPO has permission to procure all organs from a particular donor, that OPO shall offer those organs through the Match System unless there is a contraindication to organ procurement.

Question 39

DCD guidelines specifically address what type of death?

Answer 39

Donation after Cardiac Death

Question 40

An OPO coordinator records the administration of Azithromycin, Levaquin, Dopamine, Insulin, Levothyroxine, and Dextrose in the donor record following adminstration in the ICU. During procurement the visiting lung recovery team requests doses of Lasix and Mannitol be administered during the final dissection of the lungs. Is the coordinator required to document these diuretic medications in the donor record since adminsitration took place in the OR?

• -No, the diuretics were administered so close to cross clamp, they only have an effect on the condition of the lungs.
• -Yes, all medications administered to organ donors need to be recorded during the retrieval process.
• -Only Lasix needs to be documented because of the medication’s action on the Loop of Henle

Answer 40

Yes, all medications administered to organ donors need to be recorded during the retrieval process.

Question 41

An OPO and a transplant team agree upon a set time for multiple organ procurement to begin, but the transplant team is unable to meet the agreed upon set time. Can the OPO withdraw the organ offer?

• -The host OPO must wait for the transplant team
• -After 30 minutes, the OPO can withdraw a multiple organ offer from a transplant center.
• -If the multiple organ procurement time cannot be agreed upon, the host OPO may withdraw the offer from the transplant center or OPO unable to agree upon a time for procurement to begin.

Answer 41

If the multiple organ procurement time cannot be agreed upon, the host OPO may withdraw the offer from the transplant center or OPO unable to agree upon a time for procurement to begin.

Question 42

An OPO coordinator packages one ACD “yellow top” tube and two clot “red top” tubes of blood with donor kidney for tissue typing. Additionally, the coordinator embeds in the packaging ice a conical container with two mesenteric lymph nodes in a preservation solution. Do the tissue typing materials provided with the kidney meet the requirements of OPTN policy?

• -No, two ACD “yellow top” and one clot “red top” tubes of blood must be sent with each kidney and pancreas. Additionally, three to five lymph nodes, and one 2x4 cm section of spleen (if avail) must be sent.
• -No, two yellow top and four red top tubes, and a 4x4 cm section of bone marrow must be sent with each kidney and panc.
• -Yes, ample materials for crossmatch testing are provided with each kidney from this donor.

Answer 42

No, two ACD “yellow top” and one clot “red top” tubes of blood must be sent with each kidney and pancreas. Additionally, three to five lymph nodes, and one 2x4 cm section of spleen (if avail) must be sent.

Question 43

If there is a status 1 liver candidate listed locally or regionally, can the OPO allocate a liver-intestine using the intestine match run?

• -The host OPO can bypass a local or regional status 1A and 1B liver candidate and allocate a liver-intestine using the intestine match run.
• -For candidates awaiting a combined intestine-liver transplant, the liver may be allocated by the local OPO to a local or regional intestine recipient based upon priority for receipt of the intestine using the intestine waiting list, unless there is a status 1A or 1B liver candidate locally or regionally.
• -The host OPO can only bypass status 1B candidates and allocate a liver-intestine using the intestine match run.

Answer 43

For candidates awaiting a combined intestine-liver transplant, the liver may be allocated by the local OPO to a local or regional intestine recipient based upon priority for receipt of the intestine using the intestine waiting list, unless there is a status 1A or 1B liver candidate locally or regionally.

Question 44

An OPO coordinator sends blood tubes to two separate laboratories for the ABO determination of an organ donor. One hour later, the OPO’s clinical manager arrives in the ICU to consult on the case and to enter the donor’s data into DonorNet.

The OPO coordinator and the clinical manager review the ABO test results sent via fax by each of the two laboratories. They agree that the two ABO testing reports are for the same donor and the ABO test results are identical. The OPO coordinator and clinical manager then complete the OPO’s documentation for the verification of ABO data accuracy.

The ABO documentation from the two laboratories is filed in the physical donor record. The clinical manager refers to this documentation to enter the ABO information into DonorNet. Later, the OPO coordinator, referring to the same documentation, verifies the ABO data in DonorNet. Is this OPO’s procedure for verification of the accuracy of the donor’s ABO data in compliance with OPTN policy 3.2.4?

• -No, the OPO is only required to perform one ABO test on all donors.
• -No, the OPO is not required to retain documentation of ABO testing accuracy for audit.
• -Yes, two OPO staff members view both ABO source documents and confirm the tests are for the same donor and the tests report the same result. Following this confirmation, they complete the OPO’s documentation of this verification and retain it for audit.

Answer 44

Yes, two OPO staff members view both ABO source documents and confirm the tests are for the same donor and the tests report the same result. Following this confirmation, they complete the OPO’s documentation of this verification and retain it for audit.

Question 45

During a recent regulatory audit, the investigator was monitoring a recovery case. During the recovery, the investigator learned that the case involoved a well know politician. Does the investigator have the autority to review the donor’s medical records?

• -The OPO is required by Federal Regulations to allow a governmental agency access to confidential donor information.
• -The OPO does not have the autority to share the information with any agency without the donor family’s written consent.
• -An OPO may disclose confidential information upon the approval of the Medical Director and OPO attorney.

Answer 45

The OPO is required by Federal Regulations to allow a governmental agency access to confidential donor information.

Question 46

To ensure that transported organs are maintained in good quality during transport to the transplant center and to protect the health of the organ recipients, the OPO’s written protocols will include the following controls:

• -Organ monitoring requirements to be followed during shipment
• -Guidelines for packaging, labeling, handling, and methods for shipping organs.
• -Physician instruction for emergency surgery instructions involving the organs

Answer 46

Guidelines for packaging, labeling, handling, and methods for shipping organs

Question 47

During the management of a liver and kidney DCD donor, the OPO coordinator cancelled an earlier request for a CXR because lungs were not being recovered. Is a CXR needed for a liver and kidney donor?

Answer 47

Yes, a Chest X-Ray is required for all donors, even if lungs are not recovered.

Question 48

What information must be marked on the organ packaging prior to shipment?

• -Packaging must include the donor’s SSN, name, and address.
• -Packaging must include the donor’s ID number, contact information, and SSN.
• -Packaging must include the donor’s ID number, specific contents, and donor’s blood type

Answer 48

Packaging must include the donor’s ID number, specific contents, and donor’s blood type

Question 49

During a recent recovery, an organ recovery specialist was approached by the media requesting an interview regarding the recovery. The reporter stated that he/she was investigating a high-profile case and wished to confirm if a recovery was performed on Mr. Smith. In this instance, does the specialist have the authority to confirm or deny this information?

Answer 49

No, neither the organ recovery specialist nor the OPO have the right to disclosed protected health information to the media.

Question 50

An OPO is notified by a transplant center that during inspection of the right kidney prior to transplantation, a mass is visualized. The mass is biopsied and is found to be renal cell carcinoma. The heart, liver, and left kidney have been transplanted. The OPO notifies all recipient centers of the biopsy findings. Is the OPO also required to notify UNOS of the result?

Answer 50

Yes, the OPO is required to notify UNOS of any suspected or confirmed donor related disease transmission.

Question 51

A transplant center notifies an OPO coordinator on a Friday evening that a recipient has developed mycobacterium tuberculosis (TB). The transplant center’s medical staff suspects that the donor may be the source of infection. How and when should the OPO coordinator notify UNOS of this suspected donor related transmission?

• -The OPO coordinator should immediately enter the suspected event into the Patient Safety System under the section for reporting a Potential Disease Transmission.
• -The OPO coordinator is not required to notify anyone of a suspected donor related disease transmission.
• -The OPO coordinator should wait until the transmission is confirmed to be related to the donor and then contact UNOS.

Answer 51

The OPO coordinator should immediately enter the suspected event into the Patient Safety System under the section for reporting a Potential Disease Transmission.

Question 52

When an OPO sends organ and tissue typing material to another OPO or transplant center what color blood tube must be sent?

• -The procuring OPO can send any color top tube to the transplant center.
• -The procuring OPO has to send a tube of blood to the importing OPO.
• -The procuring OPO must send a red top tube.

Answer 52

The procuring OPO must send a red top tube

Question 53

An expanded criteria donor (ECD) kidney match run has multiple zero antigen mismatches. How long, relative to cross clamp time, does the OPO have to contact the Organ Center to delegate zero mismatch kidney allocation?

• -At least two hours before cross clamp.
• -Within eight hours after cross clamp.
• -Within four hours after cross clamp.

Answer 53

Within four hours after cross clamp

Question 54

What are two pertinent tests for potential lung donors that must be done by the OPO and are essential information for lung offers?

• -Echocardiogram and Serum Glucose
• -Brood group subtyping of ABO A donors and a 12 lead ECG.
• -Blood gases and Sputum Gram Stain

Answer 54

Blood gases and Sputum Gram Stain

Question 55

In making a referral of a potential donor, the nurse gives the OPO, or its designee, the following information: name, age, sex, height, and weight. Did the nurse incorrectly disclose any confidential information?

• -Yes, a hospital may disclose confidential information only upon the approval of the medical director and hospital attorney.
• -No, a hospital may disclose confidential information regarding a potential donor to a procurement organization.
• -Yes, a hospital doesn’t have the authority to share the information with any agency without the donor family’s written consent.

Answer 55

No, a hospital may disclose confidential information regarding a potential donor to a procurement organization.

Question 56

During a national learning session, a public relations firm contacted a staff member of an OPO. The firm’s representative requested a list of donor families. Per the representative, the firm’s goal is to produce a commercial regarding organ donation. The commercial is expected to play during the Rose Bowl and will have a large audience. Is it acceptable to provide a list of donors to the Public Relations representative without donor family approval?

• -The OPO would be responsible to first investigate the PR firm to ensure their legitimacy. If the firm has evidence of work on a donation commercial, it would be appropriate to provide the list.
• -The OPO may not provide the list without the consent of each person on the list.
• -Access to donor records would be acceptable, providing the PR firm registered with the governing regulatory agency.

Answer 56

The OPO may not provide the list without the consent of each person on the list

Question 57

When an OPO coordinator reviews a match run and notices that there is a liver-kidney candidate outside of the donor service area, does an offer have to be made to the transplant center with the liver-kidney candidate outside of the donor service area before any local offers are made?

• -The OPO must rerun the matchrun, notify the transplant centers within their distribution unit for bypass codes, and make the multiple organ offer to the transplant center outside of their distribution unit.
• -No, if the multiple organ candidate is on a waiting list outside the local organ distribution unit where the donor is located, voluntary sharing of the second organ is recommended
• -The OPO is required to bypass all of the transplant centers within their donor service area and make the multiple organ offer to the transplant center outside of their donor service area.

Answer 57

.No, if the multiple organ candidate is on a waiting list outside the local organ distribution unit where the donor is located, voluntary sharing of the second organ is recommended

Question 58

The kidney match run for a 45 year old donor shows two regional zero-antigen mismatches and one kidney payback due. Additionally, there are two local mismatched high PRA (>80%) candidates. According to OPTN policy can the OPO keep both kidneys locally for the high PRA patients?

• -No. One kidney must be offered to the zero-antigen matches. (If a zero-antigen mismatch recipient accepts the kidney and is transplanted, then the payback is satisfied)
• -No. Neither kidney can be used locally.
• -Yes. Both kidneys can be used locally.

Answer 58

No. One kidney must be offered to the zero-antigen matches. (If a zero-antigen mismatch recipient accepts the kidney and is transplanted, then the payback is satisfied)