NNCC Transplant Bonus Questions

COVID19

Question Title

* A large metropolitan hospital has reported an increasing number of COVID-19 cases daily. The transplant program director, with input from the team, has decided that it is prudent, from both a safety and resource perspective, to inactivate the transplant program.

1. In accordance with United Network for Organ Sharing (UNOS) regulations, the transplant program is required to

a. provide the names of the current wait list patients to the Organ Procurement and Transplantation Network (OPTN).

b. transfer the patients to an active transplant program within a reasonable geographic distance.

c. send the notification certified mail to all patients within 72 hours.

d. notify the OPTN of the transplant program inactivation status.

The correct answer is d. notify the OPTN of the transplant program inactivation status.

Rationale: Transplant programs are required to notify the OPTN of their inactivation status. Patients are required to be notified within a reasonable time frame but not necessarily within 7 days, if that poses a difficulty, and proof of receipt is not required. Communication may be sent by letter, mass email, website notification, or other methods deemed appropriate and the transplant program must provide information to OPTN regarding how the patients were notified.

Reference: https://unos.org/wp-content/uploads/unos/FAQs-inactivation-during-COVID19-03232020.pdf

Question Title

* 2. When contacting the patients on the active wait list about the transplant program inactivation, the communication should state that the inactivation is based on the national emergency caused by the COVID-19 pandemic and should also inform that the patients that they will

a. continue to accrue waiting time on the list

b. be crossmatched for 6 antigen matched kidneys.

c. require COVID-19 testing prior to wait list reactivation.

d. receive organ offers from other local programs.

The correct answer is a. continue to accrue waiting time on the list

Rationale: According to UNOS, the transplant program, in its communication to patients, should let them know that, during the time that the program is inactive, the patients will continue to accrue waiting time. However, they will not receive any organ offers from the transplant program. Patients may request to transfer to other transplant program but those programs have to complete their own evaluation according to their criteria to determine whether the patient is suitable.

Reference: https://unos.org/covid/#AnchorTemplateLetters
https://unos.org/wp-content/uploads/unos/FAQs-inactivation-during-COVID19-03232020.pdf

Question Title

* 3. A patient with ESRD, not on dialysis, has been scheduled for a pre-emptive living donor kidney transplant. According to American Society of Transplantation (AST) recommendations, the donor underwent both epidemiology and clinical screening for COVID-19 and was determined to be at intermediate risk (exposed but asymptomatic for 14 days).

Prior to the transplant surgery being scheduled, AST recommends that the potential donor should undergo which of the following tests?

a. nasopharyngeal/oropharyngeal swab, only.

b. nasopharyngeal/oropharyngeal swab and blood nucleic acid testing (NAT), only.

c. nasopharyngeal/oropharyngeal swab, blood NAT, and chest x-ray (CXR), only.

d. nasopharyngeal/oropharyngeal swab, blood NAT, CXR, and chest computed tomography (CT).

The correct answer is b. nasopharyngeal/oropharyngeal swab and blood nucleic acid testing (NAT), only.

Rationale: Consider delaying transplant for living donors who are classified as intermediate risk due to exposure but who have no symptoms of illness for 14 days. They should be counseled about ways to decrease transmission and should be tested for SARS-CoV-2 prior to transplant to document negative status (nasopharyngeal/oropharyngeal) and blood NAT testing.

Clinicians considering use of chest CT scans for diagnosis or management of COVID-19 patients should consider whether such imaging will change clinical management. The American College of Radiology (ACR) recommends that CT should not be used to screen for COVID-19, or as a first-line test to diagnose COVID-19, and that CT should be used sparingly and reserved for hospitalized, symptomatic patients with specific clinical indications for CT. The Centers for Disease Control and Prevention (CDC) does not currently recommend CXR or CT to diagnose COVID-19. Viral testing remains the only specific method of diagnosis. The Centers for Disease Control (CDC) does not currently recommend CXR or CT to diagnose COVID-19. Viral testing remains the only specific method of diagnosis.

Reference: https://www.myast.org/sites/default/files/COVID19%20FAQ%20Tx%20Centers%2004.06.2020%20%282%29.pdf
https://www.myasorg/information-transplant-professionals-and-community-members-regarding-2019-novel-coronavirus
https://www.acr.org/Advocacy-and-Economics/ACR-Position-Statements/Recommendations-for-Chest-Radiography-and-CT-for-Suspected-COVID19-Infection

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