Deceased Donor Procurement

Question 1

OPO responsibilities (There are 15 listed!)

Answer 1

1. Identifying potential deceased donors
2. Providing evidence of authorization for donation
3. Evaluating deceased donors
4. Maintaining documentation used to exclude any patient from the imminent neurological death data definition or the eligible data definition
5. Verifying that death is pronounced according to applicable laws
6. Establishing and then implementing a plan to address organ donation for diverse cultures and ethnic populations
7. Ensuring the clinical management of the deceased donor
8. Ensuring that the necessary tissue-typing material is procured, divided, and packaged
9. Assessing deceased donor organ quality
10. Preserving, labeling, packaging, and transporting the organs. Labeling and packaging must be completed using the OPTN organ tracking system according to policy 16.
11. Executing the match run and using the resulting match for each deceased donor organ allocation ( Does not apply to covered VCA transplants which instead must be allocated by policy 12.2)
12. Documenting and maintaining complete deceased donor information for 7 years for all organs procured.
13. Ensuring that all deceased donor information is reported to the OPTN upon receipt to enable complete and accurate evaluation of donor suitability by transplant programs
14. (Specifies required information of #13) Ensuring documentation is submitted for ABO source documentation, ABO subtype source documentation, infectious disease results source documentation, death pronouncements source documentation, authorization for donation source documentation, and HLA typing source documentation
15. Maintaining blood specimens appropriate for serologic and nucleic acid testing (NAT) as available for each deceased donor for at least ten years after the date of organ transplant and ensuring their availability for retrospective testing.

Question 2

Evaluating and screening potential deceased donors

Answer 2

1. Attempt to obtain the deceased donor’s medical and behavioral history from one or more individuals familiar with the donor to screen for medical conditions that may affect the decision to use the donated organ.
2. Review the deceased donor’s medical record
3. Complete a physical examination of the deceased donor including the donor’s vital signs
4. Document in the deceased donor medical record if any of this information is not available and the reason it is not available

Question 3

Deceased donor medical and behavioral history

Answer 3

1. Any testing and lab results used to identify the presence of transmissible diseases, malignancies, or conditions, treated or untreated that may be transmitted to the recipient
2. Whether the potential deceased donor has any risk factors associated with disease transmission including bloodborne pathogens (HIV, HBV,HCV)
3. Whether the potential deceased donor has a history of prior exposure or treatment with human petuitary derived growth hormone (HPDGH) which would implicate an increased risk of prion disease

Question 4

Deceased donor blood type determination

Answer 4

At least two donor blood samples must be submitted, drawn on separate occasions, at different collection times, and submitted as separate samples prior to the match run

Question 5

Deceased donor blood subtype determination

Answer 5

Deceased donor blood samples for subtyping must be tested using pre-red blood cell transfusion samples, be drawn on 2 separate occasions, have different collection times, and be submitted as separate samples.

Question 6

Reporting of deceased donor blood type and subtype

Answer 6

1. Two different qualified health care professionals must each make an independent report of the donor’s blood type to the optn
2. If the donor’s subtype is required for allocation 2 qualified healthcare professionals must report the subtype to the OPTN
3. Both qualified health care professionals must use all known available blood types and subtype determination source documents to verify they contain accurate information

Question 7

Exceptions to the hiv screening requirement

Answer 7

Exceptions to the HIV screening requirement may be made for organs OTHER THAN kidneys when an extreme medical emergency warrants the transplantation of an organ that has not been tested for HIV. In this case:

OPO must provide all available deceased donor medical and social history to the transplant program and treat the deceased donor as having any risk criteria for acute hiv hbv or hcv infection

Receiving hospital must inform the potential transplant recipient or the recipient’s authorized agent before transplantation and obtain HIV screening test results prior to storing sharing or using the extra vessels in another recipient

Question 8

Required deceased donor general risk assessment (7 evals)

Answer 8

1. arterial blood gas results
2. Blood type determination and reporting
3. Chest xray
4. Complete blood count (CBC)
5. Electrolytes
6. serum glucose
7. Urinalysis within 24 hours before cross clamp

Question 9

Required deceased donor infectious disease testing (11 specific disease tests)

Answer 9

blood and urine cultures, as well as the following tests:
1. HIV antibody test (can be combined with HIV antigen test)
2. HIV RNA test/ diagnostic nucleic acid test
3. HepB surface antigen test
4. HepB core antibody test
5. HepB DNA test
6. HepC antibody test
7. HepC RNA test
8. Cytomegalovirus (CMV) antibody test
9. Epstein-barr antibody test
10. Syphilis screening
11. Toxoplasma immunoglobin G antibody test

Question 10

Which infectious disease test is required specifically for the lungs?

Answer 10

Sars-CoV-2!

Question 11

Required deceased donor information (13 data points)

Answer 11

1. Age
2. diagnosis/cause of death
3. Donor behavioral and social history
4. Donor management info
5. donor medical history
6. Donor evaluation information including all laboratory testing radiologic results and injury to the organ
7. Ethnicity
8. Height
9. Organ anatomy and recovery information
10. Sex
11. All vital signs including BP, hr, and temp
12. Weight
13. Covid-19 testing status

Question 12

Required information for deceased kidney donors ( 6 data points)

Answer 12

1. Anatomical description including number of blood vessels, ureters, and approximate length of each
2. HLA information
3. Injuries or abnormalities
4. Perfusion information if performed
5. Kidney laterality
6. Biopsy results

Question 13

Due cause to perform a kidney biopsy (excluding donors under 18 years old):

Answer 13

1. Anuria
2. Donor has received hemodialysis or other renal replacement therapy during current hospital admission or in the care of donor management
3. History of diabetes or HbA1C of 6.5 or greater
4. KDPI greater than 85% at time of match run
5. Donor age 60+
6. Donor age 50-59 with history of hypertension, Terminal serum creatinine 1.5+mg/dl, or cause of death was a CVA

Question 14

Required information for deceased liver donors

Answer 14

1. HLA information
2. Other lab testing - ALT/AST, alkaline phosphate, total and direct bilirubin, international normalized ration or prothrombin, partial thromboplastin time
3. Pre-procurement biopsy results if performed
4. Pre-procurement CT results if performed

Question 15

Required information for deceased heart donors (5 data points)

Answer 15

1. 12-lead electrocardiogram interpretation if available
2. Arterial blood gas results and ventilator settings
3. Cardiology consult if performed
4. Echocardiogram
5. HLA information

Question 16

Required information for deceased lung donors (6 data points)

Answer 16

1. Arterial blood gasses and ventilator settings within 2 hours prior to the offer
2. Bronchoscopy results if performed
3. Chest x ray interpreted by a radiologist or qualified physician within three hours prior to the offer
4. HLA information
   5.Sputum gran stain
5. Lung laterality

Question 17

Required information for deceased pancreas donors (6 data points)

Answer 17

1. Family history of diabetes.
2. Hemoglobin A1C if performed
3. HLA information
4. Insulin protocol
5. Serum amylase
6. Serum lipase

Question 18

Who may not participate in the recovery or transplantation of organs due to a conflict of interest?

Answer 18

The potential deceased donor’s attending physician at time of death, and the physician who declares the time of death

Question 19

Organ procurement procedures (7 procedures)

Answer 19

1. Ensure that the deceased donor receives medications at appropriate times.
2. Document any medications administered in the deceased donor’s record
3. Begin tissue typing and cross matching as soon as possible.
4. Use standard surgical techniques in a sterile environment
5. Maintain flush solutions, additives, and preservation media at appropriate temperatures
6. Document flush solutions and additives with lot numbers, along with organ anatomy, organ flush characteristics, flush solution amount, and flush solution type in the deceased donor record
7. Document any organ abnormalities and surgical damage for all organs except extra vessels