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DONATION AFTER THE CIRCULATORY DETERMINATION OF DEATH - Beatriz Dominguez-Gil

In which of the following aspects does the Paris classification (2015) of DCDD donors different from the corresponding Maastricht classification (1995)?

It identifies five instead of four categories of DCDD donors

It does not refer to the terms “controlled” and “uncontrolled” DCDD do-nors

It defines a new category III of DCDD donors, as those who have been declared dead following the withdrawal of life-sustaining therapies

It subclassifies category II DCD donors in categories IIa and IIb, de-pending on whether the cardiac arrest preceding death occurs outside or inside the hospital, respectively

DONATION AFTER THE CIRCULATORY DETERMINATION OF DEATH - Beatriz Dominguez-Gil

The functional warm ischemia time in controlled DCDD is defined as:

The time extending from admission to the ICU until the decision to withdraw life-sustaining therapies

The time extending from the moment of terminal extubation until signif-icant hypoperfusion of organs

The time extending from significant hypoperfusion of organs until cold preservation or in situ regional perfusion

The time extending from significant hypoperfusion of organs until the determination of death

DONATION AFTER THE CIRCULATORY DETERMINATION OF DEATH - Beatriz Dominguez-Gil

The determination of death by circulatory criteria following the withdrawal of life- sustaining therapies is based on:

The irreversible (“cannot return”) cessation of systemic circulation

The permanent (“will not return”) cessation of systemic circulation

The permanent (“will not return”) cessation of circulation to the brain

The irreversible (“cannot return”) loss of neurologic functions

DONATION AFTER THE CIRCULATORY DETERMINATION OF DEATH - Beatriz Dominguez-Gil

Outcomes of organs obtained from donors declared dead by circulatory criteria are more likely to:

Develop delayed graft function in kidney transplantation

Develop ischemic-type biliary lesions after liver transplantation

a and b are correct

Display better graft survival at one year after transplantation

DONATION AFTER THE CIRCULATORY DETERMINATION OF DEATH - Beatriz Dominguez-Gil

An early conversion of possible donors after brain death into donors declared dead by circulatory criteria in controlled circumstances:

Must be avoided as much as possible

Requires the consideration of whether brain death is a likely outcome should the withdrawal of life-sustaining therapies be delayed

The possibility of delaying decisions to withdraw of life-sustaining thera-pies must be considered following an informative process with relatives and the treating team

All of the above

Brain death – Julien Charpentier

The diagnosis of brain death should be made first with regard to:

National recommendation

Your own experience

Legal recommendation

Medical knowledge

Brain death – Julien Charpentier

In the concept of whole brain death, choose the correct answer:

It concerns the brain stem and the cerebral hemispheres

The brain stem is not involved

The apnea test is not important in this context

The brainstem reflex does not need to be tested

Brain death – Julien Charpentier

Which of the following conditions is not required before a diagnosis of brain death can be made?

Body temperature > 35°C

A known cause of death

Family consent

A mean blood pressure > 60 mmHg

Brain death – Julien Charpentier

Which of the following symptoms is not consistent with a diagnosis of brain death?

arm movement after upper lip stimulation

High blood pressure

Polyuria

Leg movement after hand stimulation

Brain death – Julien Charpentier

Regarding the apnea test, what is the correct answer if the test is positive?

PaCO2 is the only criteria.

Hypoxemia is the strongest stimulation of the respiratory centers.

It is a safe procedure because it is performed after a clinical exception.

The respiratory centers are located in the brainstem.

Confirmation of death in DCD A brain-based diagnosis - Alexander Manara

The 5 minutes observation (“No touch”) period before confirming death starts

From the onset of apnoea

From the time the carotid pulse becomes impalpable

From the time of loss of consciousness

From the simultaneous loss of the circulation, breathing and con-sciousness

From the time heart sounds and breath sounds are no longer au-dible

Confirmation of death in DCD A brain-based diagnosis - Alexander Manara

When confirming death using circulatory criteria in someone receiving mechanical ven tilation:

The five minutes observation time in an asystolic patient should start only after the patient is disconnected from the ventilator

The application of PEEP should be continued during the observation pe-riod to maintain lung expansion if lung donation is being planned

Mechanical ventilation can be continued while observing for 5 minutes loss of the circulation and unresponsiveness.

Mechanical ventilation can continue if the “apnoea ventilation” mode on the ventilator is switched off

The patient should be extubated first

Confirmation of death in DCD A brain-based diagnosis - Alexander Manara

After 5 minutes of cardiorespiratory arrest, it is safe to diagnose death because

It will no longer be possible to restart the heart

The period of time after which spontaneous resuscitation will oc-cur has passed

The brain will have suffered irreversible necrosis

To wait any longer would compromise donated organ function

No one has ever had a good neurological outcome after such a long period of asystole

Confirmation of death in DCD A brain-based diagnosis - Alexander Manara

The absence of mechanical cardiac function is normally confirmed using a combination of the following:

The absence of a central pulse on palpation or arterial line and the absence of heart sounds on auscultation.

The absence of a central pulse on palpation or arterial line and a prolonged central capillary refill time.

The absence of heart sounds on auscultation and a prolonged central capillary refill time.

The absence of palpable heart contractions on the chest and the absence of heart sounds on auscultation.

The absence of a radial pulse on palpation and the absence of heart sounds on auscultation.

Confirmation of death in DCD A brain-based diagnosis - Alexander Manara

With regards to organ retrieval following diagnosis of death using circulatory criteria

Death must occur within 1 hour to allow donation to proceed

It is ethically acceptable to change usual practices around end of like care to facilitate donation

If no ICU staff are available, a member of the transplant team may di-agnose death

Retrieval must always take place in daytime hours

It is impossible to retrieve the heart in a DCD donation

Multi-organ retrieval – Gabriel C. Oniscu

During DCD multi-organ procurement, the preferred portal vein perfusion is best undertaken via:

Superior mesenteric vein

Portal vein

Inferior mesenteric vein

No portal perfusion should be undertaken

Multi-organ retrieval – Gabriel C. Oniscu

The functional warm ischaemic time in DCD donation is most commonly defined as :

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

Colour and Liver consistency

Sharpness of the edges

All of the above

Multi-organ retrieval – Gabriel C. Oniscu

The following characteristics define an extended DCD liver graft:

Age < 50

Donor weight > 100 Kg

ICU stay < 5 days

Functional warm ischemic time >30 min

Cold ischemic time > 8 hours

Multi-organ retrieval – Gabriel C. Oniscu

The use of normothermic regional perfusion during DCD donation:

Increases organ utilisation

Allows a functional assessment of liver function

Is potentially associated with reduced organ injuries

Reduces the incidence of ischaemic biliary complications post liver transplant

All of the above

Ex vivo perfusion - Philipp Dutkowski

Which machine perfusion techniques are currently clinical relevant?

normothermic

hypothermic

subnormothermic

supercooling

hyperthermic

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

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 recipient

Ex vivo perfusion - Philipp Dutkowski

What are the most important factors of HOPE?

hypothermic conditions

oxygenated perfusate

UW gluconate

2 h perfusion

endischemic application

Ex vivo perfusion - Philipp Dutkowski

What are the most important factors of NMP?

20 h perfusion

blood based perfusate

organ nutrition

endischemic application

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 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?

HCV-RNA

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

HBV-DNA

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?

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

Only for cardiac recipients

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

Only for thoracic organ recipients

Only for liver recipients

RISK OF TRANSMISISON OF INFECTIOUS DISEASES – Paolo Antonio Grossi

A donor with positive BAL for XDR Acinetobacter baumannii

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

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.

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.

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.

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.

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.

Risk of transmission of neoplastic disease - Chris Watson

The risk of transmission of a cancer from a donor with no known history of cancer is around

1 in 20

1 in 200

1 in 2000

1 in 20000

1 in 200000

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

History of cancer in the donor

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 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 2cm grade 3 astrocytoma

A 5mm basal cell carcinoma on the left eyelid

Risk of transmission of neoplastic disease - Chris Watson

Which of the following cancers is the most commonly reported cancer to be transmitted

Glioblastoma (grade IV glioma)

Lung cancer

Melanoma

Lymphoma

Renal cancer

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 brain biopsy

A previous resection of the glioblastoma

A ventriculo-peritoneal shunt

Chemotherapy

Cranial radiotherapy

«Meet the international experts»

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