CHT Organ & Tissue Allocation 1 — Questions and Answers
Question 1: Which US federal agency oversees the national organ transplant system and UNOS contract?
- Health Resources & Services Administration (HRSA) (Correct answer)
- Centers for Disease Control and Prevention (CDC)
- Centers for Medicare & Medicaid Services (CMS)
- Food and Drug Administration (FDA)
Correct answer: Health Resources & Services Administration (HRSA)
HRSA administers the National Organ Transplant Act (NOTA) and contracts with UNOS to operate the Organ Procurement and Transplantation Network (OPTN).
Question 2: What is the role of an Organ Procurement Organization (OPO) in the transplant system?
- Coordinates organ donation, donor evaluation, and procurement from deceased donors in a defined service area (Correct answer)
- Performs the transplant surgery in recipient hospitals
- Manages the national transplant waiting list
- Provides immunosuppressive drugs to transplant recipients
Correct answer: Coordinates organ donation, donor evaluation, and procurement from deceased donors in a defined service area
OPOs are federally designated organizations responsible for organ donor identification, family consent, medical management of brain-dead donors, and organ procurement in their DSA.
Question 3: In kidney allocation, what does 'CPRA' primarily determine?
- Priority points that highly sensitized candidates receive, increasing their chances of receiving an organ (Correct answer)
- The immunosuppression protocol for post-transplant management
- Whether the recipient needs a living versus deceased donor
- The organ quality score for deceased donor kidneys
Correct answer: Priority points that highly sensitized candidates receive, increasing their chances of receiving an organ
High CPRA recipients receive additional priority points in UNOS kidney allocation policy to compensate for their reduced compatible donor pool.
Question 4: What is the definition of 'brain death' relevant to deceased donor organ procurement?
- Irreversible cessation of all functions of the entire brain, including the brainstem (Correct answer)
- Irreversible cessation of cardiac function only
- Persistent vegetative state without recovery potential
- Loss of cortical function with preserved brainstem reflexes
Correct answer: Irreversible cessation of all functions of the entire brain, including the brainstem
Brain death (neurological determination of death) requires irreversible loss of all brain functions including the brainstem, confirmed by clinical examination and often ancillary testing.
Question 5: What is a 'Donation after Circulatory Death' (DCD) donor?
- A donor whose death is declared by circulatory criteria after planned withdrawal of life support (Correct answer)
- A donor whose heart is restarted after procurement
- A living donor who donates after a cardiac surgery
- A donor declared brain dead with cardiac complications
Correct answer: A donor whose death is declared by circulatory criteria after planned withdrawal of life support
DCD donors are individuals whose death is determined by irreversible cessation of circulatory function, typically after deliberate withdrawal of life-sustaining treatment.
Question 6: Which allocation policy requires that organs be offered locally, then regionally, then nationally?
- The former geographic-based UNOS allocation policy (largely replaced by continuous distribution for some organs) (Correct answer)
- The CPRA matching algorithm
- The zero-mismatch allocation mandate
- The emergency status allocation only
Correct answer: The former geographic-based UNOS allocation policy (largely replaced by continuous distribution for some organs)
UNOS historically used local-regional-national geographic sequencing for organ offers, though newer continuous distribution models for hearts and livers prioritize medical urgency and compatibility over geography.
CHT Organ & Tissue Allocation 1
Which US federal agency oversees the national organ transplant system and UNOS contract?