Multi-organ retrieval – Gabriel C. Oniscu The functional warm ischaemic time in DCD donation is most commonly defined as :

The time from systolic BP of <50 mmHg to in situ perfusion

The time from treatment withdrawal to circulatory arrest

The time from treatment withdrawal to in situ perfusion

The time from systolic BP of <50 mmHg to circulatory arrest

The time from systolic BP of <50 mmHg to in situ perfusion

The time from circulatory arrest to in situ perfusion

Multi-organ retrieval – Gabriel C. Oniscu Liver assessment during DBD retrieval is based on the following:

In situ appearance of the liver

Ex situ (post perfusion) appearance of the liver

Multi-organ retrieval – Gabriel C. Oniscu The following characteristics define an extended DCD liver graft:

Donor weight > 100 Kg & Functional warm ischemic time >30 min & Cold ischemic time > 8 hours

Functional warm ischemic time >30 min

Multi-organ retrieval – Gabriel C. Oniscu The use of normothermic regional perfusion during DCD donation:

Allows a functional assessment of liver function

Is potentially associated with reduced organ injuries

Reduces the incidence of ischaemic biliary complications post liver transplant

Ex vivo perfusion - Philipp Dutkowski What are key signals of ischemia reperfusion in all organs?

release of danger proteins & release of reactive oxygen species & mitochondrial injury & endothelial injury & leukocyte activation

release of reactive oxygen species

Ex vivo perfusion - Philipp Dutkowski Which ex vivo perfusion applications are possible?

perfusion in the donor and subsequent cold storage & perfusion after retrieval and transport by cold storage & perfusion during organ transport instead of cold storage & perfusion after cold storage (endischemic)

perfusion in the donor and subsequent cold storage

perfusion after retrieval and transport by cold storage

perfusion during organ transport instead of cold storage

perfusion after cold storage (endischemic)

Ex vivo perfusion - Philipp Dutkowski What are the most important factors of HOPE?

hypothermic conditions & oxygenated perfusate

Ex vivo perfusion - Philipp Dutkowski What are the most important factors of NMP?

blood based perfusate & organ nutrition & oxygenated perfusate

RISK OF TRANSMISISON OF INFECTIOUS DISEASES – Paolo Antonio Grossi Which tests are mandatory prior to organ procurement for deceased and living donor evaluation?

Anti-HIV, HBsAg, anti-HBc, anti-HCV, SARS-CoV-2-RNA on nasopha-ringeal swab or BAL

Anti-HIV, HBsAg, anti-HBc, anti-HCV, SARS-CoV-2-RNA on nasopharingeal swab or BAL, anti-CMV-IgG, anti-Toxoplasma-IgG

Anti-HIV, HBsAg, anti-HBc, anti-HCV, anti-HEV, SARS-CoV-2-RNA on nasopha-ringeal swab or BAL, anti-CMV-IgG, anti-Toxoplasma-IgG

Anti-HIV, HBsAg, anti-HBc, anti-HCV, SARS-CoV-2-RNA on nasopha-ringeal swab or BAL

Anti-HIV, HBsAg, anti-HBc, anti-HCV, anti-HEV, SARS-CoV-2-RNA on nasopha-ringeal swab or BAL, anti-CMV-IgG, anti-Toxoplasma-IgG, anti-treponema palli-dum

RISK OF TRANSMISISON OF INFECTIOUS DISEASES – Paolo Antonio Grossi Which additional tests are required for donors at risk for HIV, HBV and HCV according to the 2020 PHS definition?

HIV-RNA, HBV-DNA, HCV-RNA by NAT

Antibodies against Treponema pallidum

RISK OF TRANSMISISON OF INFECTIOUS DISEASES – Paolo Antonio Grossi Which additional tests are required for donors born in Latin America or have received blood components or products while resident in Latin America or lived in rural subsistent farming communities for a continuous period of 4 weeks or more in Latin America or individuals whose mothers were born in Latin America?

Serology with validated antibody assays for Trypanosoma cruzi

Screening for Plasmodium falciparum (blood smears, liver biopsy, PCR or antigen assays)

Screening for Strongyloides stercoralis (serology)

Serology with validated antibody assays for Trypanosoma cruzi

Serology and Western blot for HTLV

RISK OF TRANSMISISON OF INFECTIOUS DISEASES – Paolo Antonio Grossi Screening for antibodies against Toxoplasma gondii is required for deceased and living donors

For every donor (deceased or living) regardless of the type of procured organ

Only for thoracic organ recipients

RISK OF TRANSMISISON OF INFECTIOUS DISEASES – Paolo Antonio Grossi A donor with positive BAL for XDR Acinetobacter baumannii

All organs can be transplanted excluding the lungs, provided that cultures from other sites (blood and urine) are negative

Should always be excluded from organ donation

All organs can be transplanted excluding the lungs, provided that cultures from other sites (blood and urine) are negative

All organs can be transplanted without restrictions

Only the kidneys can be transplanted

Risk of transmission of neoplastic disease - Chris Watson Which of the following is least likely to be a feature of a donor transmitted cancer in a male kidney recipient

Renal cell cancer occurring in the donor kidney 5 years post-transplant

Choriocarcinoma metastases in the transplanted kidney

Lung cancer metastases in the transplanted kidney

Renal cell cancer in the paired donor kidney diagnosed 6 months post-transplant

Risk of transmission of neoplastic disease - Chris Watson The following cancers were found in potential organ donors. Which is associated with least risk of transmission to a liver recipient

A 5mm basal cell carcinoma on the left eyelid

A 1cm carcinoma of the prostate, Gleason 3+3, confined to the prostate

A 1cm Fuhrman grade II renal cell carcinoma of the right kidney

A 1cm papillary carcinoma of the thyroid

A 5mm basal cell carcinoma on the left eyelid

Risk of transmission of neoplastic disease - Chris Watson A patient with a glioblastoma is referred for possible donation. Which of the following is not a recognised adverse factor increasing the risk of transmission?

A previous resection of the glioblastoma

Risk of transmission of neoplastic disease - Chris Watson Six months after transplantation the recipient of the left kidney is identified as having a donor derived cancer. It transpires that the donor cancer has spread to all the recipients of organs from the same donor. Which recipient is likely to have the best prognosis?

The recipient of the right kidney

The recipient of the right lung

card2brain.ch

Clinical focus on Hepatitis B and C and HIV - Cedric Hirzel

Which of the following is correct?

In potential organ donors who are HBsAg positive a confirmatory NAT should be performed.

Potential organ donors with a reactive anti-HCV (serology) test will transmit the virus to potential recipients.

Potential organ donors with a reactive anti-HCV serology should undergo HCV nucleic acid testing (NAT).

Potential organ donors with a positive test result for anti-HBc antibodies should be excluded from organ donation.

In potential organ donors who are HBsAg positive a confirmatory NAT should be performed.

Potential organ donors with a reactive anti-HCV (serology) test will transmit the virus to potential recipients.

Potential organ donors with a reactive anti-HCV serology should undergo HCV nucleic acid testing (NAT).

Potential organ donors with a positive test result for anti-HBc antibodies should be excluded from organ donation.

Clinical focus on Hepatitis B and C and HIV - Cedric Hirzel

Which of the following is false?

Potential organ donors with a reactive HIV screening test (serology) and a negative HIV nucleic acid test (NAT) should be carefully eva - luated in order to clarify it they are on anti-retroviral treatment (ART).

Potential organ donors with a reactive HIV screening test and a negative HIV NAT always qualify as organ donors.

HIV positive recipients can receive organs from HIV positive do-nors as they are protected from HIV superinfection.

b and c are false.

Potential organ donors with a reactive HIV screening test (serology) and a negative HIV nucleic acid test (NAT) should be carefully eva - luated in order to clarify it they are on anti-retroviral treatment (ART).

Potential organ donors with a reactive HIV screening test and a negative HIV NAT always qualify as organ donors.

HIV positive recipients can receive organs from HIV positive do-nors as they are protected from HIV superinfection.

b and c are false.

Clinical focus on Hepatitis B and C and HIV - Cedric Hirzel

HIV nucleic acid testing (NAT) is recommended in high-risk donors as it:

Reduces the eclipse period and therefore allows an earlier diagnosis.

Reduces the window period and therefore allows an earlier diagnosis.

Reduces the likelihood of missing an HIV-2 infection.

Helps to identify individuals with resistant HIV.

Reduces the eclipse period and therefore allows an earlier diagnosis.

Reduces the window period and therefore allows an earlier diagnosis.

Reduces the likelihood of missing an HIV-2 infection.

Helps to identify individuals with resistant HIV.

Clinical focus on Hepatitis B and C and HIV - Cedric Hirzel

Potential organ donors who are anti-HBc positive and HBs-Ag negative:

Are likely to transmit the Hepatitis B virus (HBV) to HBV vaccinated kidney allograft recipients.

Solid organs from these donors will not transmit the virus to recipents.

The virus persists in the liver of these donors and can be transmit-ted by liver transplantation.

Are non-infectious as this serological constellation indicates previous HBV vaccination.

Are likely to transmit the Hepatitis B virus (HBV) to HBV vaccinated kidney allograft recipients.

Solid organs from these donors will not transmit the virus to recipents.

The virus persists in the liver of these donors and can be transmit-ted by liver transplantation.

Are non-infectious as this serological constellation indicates previous HBV vaccination.

Clinical focus on Hepatitis B and C and HIV - Cedric Hirzel

Which of the following is correct?

The Hepatitis C virus (HCV) persists lifelong in the liver of potential donors, even after treatment with direct acting antiviral agents (DAAs) and elimination of the virus from blood.

Potential organ donors with elevated liver transaminase values (ALT, ASAT) and non-reactive HCV serology might suffer from acute HCV infection.

Donor derived HCV infections are associated with a bad prognosis for the recipient.

Most HCV infections resolve spontaneously.

The Hepatitis C virus (HCV) persists lifelong in the liver of potential donors, even after treatment with direct acting antiviral agents (DAAs) and elimination of the virus from blood.

Potential organ donors with elevated liver transaminase values (ALT, ASAT) and non-reactive HCV serology might suffer from acute HCV infection.

Donor derived HCV infections are associated with a bad prognosis for the recipient.

Most HCV infections resolve spontaneously.

Tissue Donation (Cornea / Homocraft) – Jacinto Sanchez Ibanez

Which of the following situations the deceased is elegible as tissue donor:

Any antecedent of malignancy is an absolute contraindication for tissue donors

Primary basal cell carcinoma is a contraindication

The risk is the same as with organ donors

None of them

Any antecedent of malignancy is an absolute contraindication for tissue donors

Primary basal cell carcinoma is a contraindication

The risk is the same as with organ donors

None of them

Tissue Donation (Cornea / Homocraft) – Jacinto Sanchez Ibanez

In the evaluation of tissue donor, the following steps are mandatory:

Medical and social history

Physical exam

Calculation of Hemodilution

All of them

Medical and social history

Physical exam

Calculation of Hemodilution

All of them

Tissue Donation (Cornea / Homocraft) – Jacinto Sanchez Ibanez

Which one is an absolute contraindication for cornea donors:

Donor age less than 75 years old

History of previous ocular surgery

Bacterial septicemia

Leukemia

Donor age less than 75 years old

History of previous ocular surgery

Bacterial septicemia

Leukemia

Tissue Donation (Cornea / Homocraft) – Jacinto Sanchez Ibanez

In the case of cornea grafts:

Because it is vascularized graft the risk of transmission is higher

Age donor is enough to determine the viability of the tissue

The previous antecedent of herpes infection in one eye contra indicates both corneas

All of them are false

Because it is vascularized graft the risk of transmission is higher

Age donor is enough to determine the viability of the tissue

The previous antecedent of herpes infection in one eye contra indicates both corneas

All of them are false

Tissue Donation (Cornea / Homocraft) – Jacinto Sanchez Ibanez

In the case of cardiovascular grafts (choose the correct statement):

There is no age limit

CPR does not contraindicate heart valve donation

Marfan’s syndrome is a contraindication

All of them

There is no age limit

CPR does not contraindicate heart valve donation

Marfan’s syndrome is a contraindication

All of them

Biovigilance in organ and tissue donation and transplantation – Inês Ushiro-Lumb

In relation to an unexpected event in a recipient of a solid organ transplant, the local transplant unit should:

Complete all investigations linking the donor as the source of disease transmission before reporting it to the biovigilance team

Contact other transplant centres directly in order to avoid delays

Obtain donor information from the donor hospital

Initiate prompt investigation and management of their patient and alert the biovigilance team

Complete all investigations linking the donor as the source of disease transmission before reporting it to the biovigilance team

Contact other transplant centres directly in order to avoid delays

Obtain donor information from the donor hospital

Initiate prompt investigation and management of their patient and alert the biovigilance team

Biovigilance in organ and tissue donation and transplantation – Inês Ushiro-Lumb

Which statements below are correct in relation to biovigilance systems

They are programs that must be set up independently from quality management systems due to their complex nature

Co-ordination should be carried out by trained professionals within an appointed team

Whereas SAR must be reported promptly, SAE can be dealt with by the transplant unit as the recipient has not come to harm

Certain clinical conditions require rapid escalation of communication , which could be done through a rapid alert system

They are programs that must be set up independently from quality management systems due to their complex nature

Co-ordination should be carried out by trained professionals within an appointed team

Whereas SAR must be reported promptly, SAE can be dealt with by the transplant unit as the recipient has not come to harm

Certain clinical conditions require rapid escalation of communication , which could be done through a rapid alert system

Biovigilance in organ and tissue donation and transplantation – Inês Ushiro-Lumb

The detection and communication of SAREs to the appropriate Biovigilance team

Is primarily and exclusively the responsibility of the patient ‘s responsible doctor

Applies to the immediate post-transplant period, as all untoward events should present within this time frame

May require high level of suspicion and understanding of the specific medi-cal condition in order to be linked to the transplant process

Time from transplant to recognition of SARE determines how urgent it has to be reported

Is primarily and exclusively the responsibility of the patient ‘s responsible doctor

Applies to the immediate post-transplant period, as all untoward events should present within this time frame

May require high level of suspicion and understanding of the specific medi-cal condition in order to be linked to the transplant process

Time from transplant to recognition of SARE determines how urgent it has to be reported

Biovigilance in organ and tissue donation and transplantation – Inês Ushiro-Lumb

Please indicate which statements are incorrect:

It is a powerful tool to safeguard health professionals, donors and patients

The production and dissemination of an incident report is optional, depend-ing on the impact level of the SARE

Despite biovigilance teams training, expert advice is often required in SARE investigations

Biovigilance programs serve exclusively the needs of the regulatory authori-ties

It is a powerful tool to safeguard health professionals, donors and patients

The production and dissemination of an incident report is optional, depend-ing on the impact level of the SARE

Despite biovigilance teams training, expert advice is often required in SARE investigations

Biovigilance programs serve exclusively the needs of the regulatory authori-ties

Situation in Europe: legislation/consent modali; Mihaly Sandor

Which is the most common legal system in European countries regarding or-gan donation from deceased?

Presumed/deemed consent (Opting-out).

Explicit consent (Opting-in).

Mixed system with both type of registries.

There is no legislation in place in most countries.

Tastatur-Befehle:

= drehen,

= vor-/rückwärts,

= scrollen

Presumed/deemed consent (Opting-out).

Explicit consent (Opting-in).

Mixed system with both type of registries.

There is no legislation in place in most countries.

Situation in Europe: legislation/consent modali; Mihaly Sandor

Main characteristics of public knowledge and attitude about organ donation in Europe:

40% of Europeans have raised the issue of organ donation and transplantation with their family.

28% of Europeans are aware of laws governing the dona-tion and transplantation of organs in their country.

55% of Europeans are willing to donate their organs after their death.

Tastatur-Befehle:

= drehen,

= vor-/rückwärts,

= scrollen

40% of Europeans have raised the issue of organ donation and transplantation with their family.

28% of Europeans are aware of laws governing the dona-tion and transplantation of organs in their country.

55% of Europeans are willing to donate their organs after their death.

Situation in Europe: legislation/consent modali; Mihaly Sandor

Regardless of the law applied for organ donation from deceased, the role of the health care professionals who are responsible for the com-munication with the donor family is:

to ensure that the patient’s wish will be respected,

to ensure that family members understand the situation and the pro cess, and their wishes are also considered, meanwhile the patient’s wish have to be respected as first,

to ensure that the family members understand the situation and the process, and only the relatives’ wishes will be respected.

Tastatur-Befehle:

= drehen,

= vor-/rückwärts,

= scrollen

to ensure that the patient’s wish will be respected,

to ensure that family members understand the situation and the pro cess, and their wishes are also considered, meanwhile the patient’s wish have to be respected as first,

to ensure that the family members understand the situation and the process, and only the relatives’ wishes will be respected.

Situation in Europe: legislation/consent modali; Mihaly Sandor

What is the most common reason for failure of organ donation among identified and reported potential donors?

Medical unsuitability

Legal reason

Organizational reasons and lack of capacity

Family refusal

Tastatur-Befehle:

= drehen,

= vor-/rückwärts,

= scrollen

Medical unsuitability

Legal reason

Organizational reasons and lack of capacity

Family refusal

Situation in Europe: legislation/consent modali; Mihaly Sandor

Some main roles of family conversations:

We need to have hospital level standpoint agreed in ad-vance how we handle the family protest.

We should talk about donation after we made sure the family understood death.

The conversation and the family should be guided as part of our support.

We have to provide information and do not ask for consent directly.

Tastatur-Befehle:

= drehen,

= vor-/rückwärts,

= scrollen

We need to have hospital level standpoint agreed in ad-vance how we handle the family protest.

We should talk about donation after we made sure the family understood death.

The conversation and the family should be guided as part of our support.

We have to provide information and do not ask for consent directly.

Ethics in organ donation (deceased and living) – Dr. José-Maria Dominguez-Roldan

Autonomy of the person is essential for voluntary consent in organ donation. Which of these characteristics is not associated to a voluntary consent?

Consent must be given freely

Consent must be a deep emotional decision.

Consent must be given by a competent person.

Consent must be informed.

Tastatur-Befehle:

= drehen,

= vor-/rückwärts,

= scrollen

Consent must be given freely

Consent must be a deep emotional decision.

Consent must be given by a competent person.

Consent must be informed.

Ethics in organ donation (deceased and living) – Dr. José-Maria Dominguez-Roldan

Regarding living donation one of the following asseveration is not right.

Organ donation from the related donor never requires a review by the Ethics Committee.

In the case of unrelated living donor donation, it is ethical to eval-uate the donor's freedom in decision-making.

The living donor must have the option to withdraw consent till the moment of donation.

Altruism is the main driver of living donor donation.

Tastatur-Befehle:

= drehen,

= vor-/rückwärts,

= scrollen

Organ donation from the related donor never requires a review by the Ethics Committee.

In the case of unrelated living donor donation, it is ethical to eval-uate the donor's freedom in decision-making.

The living donor must have the option to withdraw consent till the moment of donation.

Altruism is the main driver of living donor donation.

Ethics in organ donation (deceased and living) – Dr. José-Maria Dominguez-Roldan

Regarding living donor donation, points out that the right answer.

Genetically/emotionally related donation is ethical correct.

Paired/pooled Exchange donation is ethically correct.

Non-directed altruistic donation is ethically correct.

All of the answers above are correct.

Tastatur-Befehle:

= drehen,

= vor-/rückwärts,

= scrollen

Genetically/emotionally related donation is ethical correct.

Paired/pooled Exchange donation is ethically correct.

Non-directed altruistic donation is ethically correct.

All of the answers above are correct.

Ethics in organ donation (deceased and living) – Dr. José-Maria Dominguez-Roldan

In an ethical analysis of organ donation with expanded criteria, point out which of the following statements is incorrect.

Organ donation with expanded criteria is ethically correct even though it is associated to Medically or immunologically higher risk.

Transplantation with expanded criteria kidneys is not ethically cor-rect because is worse option than dialysis.

Transplantation with organs from donors with expanded criteria requires specific and detailed informed consent.

Organ donation with expanded criteria, is ethically correct if insuf-ficient the number of optimal organs donated

Tastatur-Befehle:

= drehen,

= vor-/rückwärts,

= scrollen

Organ donation with expanded criteria is ethically correct even though it is associated to Medically or immunologically higher risk.

Transplantation with expanded criteria kidneys is not ethically cor-rect because is worse option than dialysis.

Transplantation with organs from donors with expanded criteria requires specific and detailed informed consent.

Organ donation with expanded criteria, is ethically correct if insuf-ficient the number of optimal organs donated

Donor Detection - Ignacio Martin Loeches

The most important part in organ donation is

The number of hospitals in the country

The figure of transplant coordinator team

The religion

The media support

The number of hospitals in the country

The figure of transplant coordinator team

The religion

The media support

Donor Detection - Ignacio Martin Loeches

Regarding family consent

It should be started as soon as possible

It should be signed

It should be discussed in friendly manner

It should be carried out by a trained team/person

It should be started as soon as possible

It should be signed

It should be discussed in friendly manner

It should be carried out by a trained team/person

Donor Detection - Ignacio Martin Loeches

Which of the ones is NOT an extended donor criteria?

Age

Gender

Comorbid conditions

Previous hypertension

Age

Gender

Comorbid conditions

Previous hypertension

Donor Detection - Ignacio Martin Loeches

Which of the following is NOT important regarding improvement in organization process?

Detection of potential donors

Family consent optimization

Organ donation census

Adequate training and motivation in staff.

Detection of potential donors

Family consent optimization

Organ donation census

Adequate training and motivation in staff.

Donor Detection - Ignacio Martin Loeches

Which of the following is NOT a basic principle in improving organ donation?

Transplant coordinators inside the hospitals

Quality Assurance Program in the Deceased Donation Pro-cess

Prioritising donation after circulatory death (DCD)

Close attention to the mass media with special communica-tion policy

Transplant coordinators inside the hospitals

Quality Assurance Program in the Deceased Donation Pro-cess

Prioritising donation after circulatory death (DCD)

Close attention to the mass media with special communica-tion policy

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