Donor selection criteria US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Donor selection criteria. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Donor selection criteria US Medical PG Question 1: A 60-year-old rock musician presents to the office because he has been feeling increasingly tired for the past 6 months. He has a history of intravenous drug use and alcohol abuse. He states that he feels quite tired, but he otherwise has no complaints. Physical examination is noncontributory. His laboratory values are normal other than moderately elevated liver enzymes. Which of the following additional tests should you order first?
- A. Hepatitis C virus antibodies (Correct Answer)
- B. Hepatitis B surface antigen
- C. Hepatitis E virus-specific IgM antibodies
- D. Hepatitis D virus-specific IgG antibody
- E. Hepatitis A virus-specific IgM antibodies
Donor selection criteria Explanation: ***Hepatitis C virus antibodies***
- The patient's history of **intravenous drug use** and **chronic fatigue** with **elevated liver enzymes** strongly suggests chronic viral hepatitis, with hepatitis C being the most common blood-borne infection in persons with IVDU history.
- **Hepatitis C** is the **most prevalent chronic viral hepatitis** in the United States among persons with history of injection drug use, with transmission efficiency via needle sharing being very high.
- Hepatitis C often has a **long asymptomatic phase** (decades) before symptoms like fatigue and liver damage become apparent, making antibody testing the appropriate initial screen.
- While both HBV and HCV should ultimately be screened in this patient, **HCV prevalence is significantly higher** in the IVDU population, making it the priority initial test.
*Hepatitis B surface antigen*
- While **hepatitis B** can also be transmitted via intravenous drug use and cause chronic liver disease, **hepatitis C is more prevalent** in persons with IVDU history in the United States.
- **HBsAg** is used to detect active hepatitis B infection and should also be ordered, but given resource constraints and the clinical context, **anti-HCV is the higher-yield initial test**.
- Many IVDU patients have been vaccinated against HBV, further reducing its likelihood compared to HCV (for which no vaccine exists).
*Hepatitis E virus-specific IgM antibodies*
- **Hepatitis E** is typically transmitted via the **fecal-oral route** (contaminated water) and usually causes **acute, self-limiting hepatitis**, not chronic insidious fatigue and liver enzyme elevation in a Western patient.
- **IgM antibodies** would indicate an acute infection, which is less likely given the 6-month duration of symptoms.
- HEV rarely causes chronic infection except in immunocompromised patients.
*Hepatitis D virus-specific IgG antibody*
- **Hepatitis D** requires an existing **hepatitis B infection** to replicate (it's a satellite virus), meaning you would first need to confirm chronic hepatitis B before testing for HDV.
- While HDV can cause severe liver disease and is transmitted via blood exposure, it's not the initial test to pursue without evidence of HBV co-infection.
*Hepatitis A virus-specific IgM antibodies*
- **Hepatitis A** is transmitted via the **fecal-oral route** and causes an **acute, self-limiting infection** with complete resolution, rarely leading to chronic liver disease or persistent fatigue over 6 months.
- **IgM antibodies** are indicative of acute infection, which contradicts the chronic nature of the patient's symptoms.
- HAV does not cause chronic hepatitis.
Donor selection criteria US Medical PG Question 2: An investigator is conducting a study to identify potential risk factors for post-transplant hypertension. The investigator selects post-transplant patients with hypertension and gathers detailed information regarding their age, gender, preoperative blood pressure readings, and current medications. The results of the study reveal that some of the patients had been treated with cyclosporine. This study is best described as which of the following?
- A. Cross-sectional study
- B. Retrospective cohort study
- C. Prospective cohort study
- D. Case series
- E. Case-control study (Correct Answer)
Donor selection criteria Explanation: ***Case-control study***
- A **case-control study** compares individuals with a disease (cases) to individuals without the disease (controls) to identify risk factors retrospectively.
- In this study, the investigator selects post-transplant patients **with hypertension** (the cases) and looks backward at their exposures, including cyclosporine use, to identify potential risk factors.
- The analytical goal of "identifying risk factors" and the observation that **some patients had been treated with cyclosporine** (implying comparison with those who were not) indicates a case-control design.
- Even if controls are not explicitly mentioned, the study design involves analyzing exposure patterns among cases to identify associations with risk factors.
*Case series*
- A **case series** is purely descriptive and involves collecting detailed information on a group of patients with a common condition without any comparison or analytical hypothesis testing.
- While this study does describe patients with post-transplant hypertension, the key difference is the **analytical intent** to identify risk factors, which goes beyond simple description.
- A true case series would simply report clinical characteristics without attempting to establish associations between exposures and outcomes.
*Cross-sectional study*
- A **cross-sectional study** assesses both exposure and outcome simultaneously at a single point in time to determine prevalence.
- This approach would involve surveying a population of post-transplant patients to determine the prevalence of hypertension and associated factors at that moment.
- The study described has already selected patients with the outcome (hypertension), making it retrospective rather than cross-sectional.
*Retrospective cohort study*
- A **retrospective cohort study** examines past data by first classifying patients based on **exposure status** (e.g., cyclosporine use vs. no cyclosporine), then following them forward in time to see who developed the outcome.
- The key difference is that cohort studies **start with exposure** and move to outcome, whereas this study **starts with outcome** (hypertension) and looks back at exposures.
- If the investigator had selected all transplant patients, divided them by cyclosporine exposure, and then determined hypertension rates in each group, it would be a retrospective cohort study.
*Prospective cohort study*
- A **prospective cohort study** identifies a cohort at baseline (before the outcome) and follows them forward in time to observe who develops the outcome.
- This study has already selected patients **with the outcome present**, making it retrospective rather than prospective.
- A prospective design would require identifying transplant patients at the time of transplant and following them over time to see who develops hypertension.
Donor selection criteria US Medical PG Question 3: A 45-year-old woman comes to the physician because of a 3-month history of worsening fatigue, loss of appetite, itching of the skin, and progressive leg swelling. Although she has been drinking 2–3 L of water daily, she has been passing only small amounts of urine. She has type 1 diabetes mellitus, chronic kidney disease, hypertension, and diabetic polyneuropathy. Her current medications include insulin, torasemide, lisinopril, and synthetic erythropoietin. Her temperature is 36.7°C (98°F), pulse is 87/min, and blood pressure is 138/89 mm Hg. She appears pale. There is 2+ pitting edema in the lower extremities. Sensation to pinprick and light touch is decreased over the feet and legs bilaterally. Laboratory studies show:
Hemoglobin 11.4 g/dL
Leukocyte count 6000/mm3
Platelet count 280,000/mm3
Serum
Na+ 137 mEq/L
K+ 5.3 mEq/L
Cl− 100 mEq/L
HCO3− 20 mEq/L
Urea nitrogen 85 mg/dL
Creatinine 8 mg/dL
pH 7.25
Which of the following long-term treatments would best improve quality of life and maximize survival in this patient?
- A. Peritoneal dialysis
- B. Living donor kidney transplant (Correct Answer)
- C. Cadaveric kidney transplant
- D. Hemofiltration
- E. Fluid restriction
Donor selection criteria Explanation: ***Living donor kidney transplant***
- A **living donor kidney transplant** offers the best outcomes for **quality of life and survival** in eligible patients with end-stage renal disease (ESRD), particularly when compared to dialysis, due to better graft survival rates and reduced complications.
- The patient's symptoms (fatigue, itching, leg swelling, oliguria, high urea nitrogen, creatinine, hyperkalemia, metabolic acidosis) are consistent with **ESRD**, and while she has several comorbidities, she is not explicitly stated to have contraindications for transplantation.
*Peritoneal dialysis*
- While an effective treatment for ESRD, **dialysis generally provides lower quality of life** and survival benefits compared to successful kidney transplantation.
- She already has significant fluid overload symptoms and **oliguria**, making adequate fluid removal through peritoneal dialysis potentially challenging without strict management and impacting her overall well-being.
*Cadaveric kidney transplant*
- A **cadaveric kidney transplant** is a viable option and offers better outcomes than dialysis, but it generally has **poorer graft survival** and a longer wait time compared to a living donor transplant due to delayed graft function and cold ischemia time.
- Given the option, a **living donor transplant is superior** in terms of long-term outcomes and reduces the time spent on dialysis.
*Hemofiltration*
- **Hemofiltration is a form of renal replacement therapy**, similar to hemodialysis, often used in acute settings or for critically ill patients with severe fluid overload or electrolyte imbalances.
- While it can manage her symptoms, it is not a long-term treatment that **improves quality of life or maximizes survival** better than transplantation for ESRD.
*Fluid restriction*
- **Fluid restriction** is a supportive measure to manage fluid overload in patients with ESRD; however, it addresses symptoms rather than the underlying progressive renal failure.
- While necessary as part of supportive care, it does not offer a definitive long-term solution or improve survival for ESRD, which requires **renal replacement therapy or transplantation**.
Donor selection criteria US Medical PG Question 4: A 50-year-old morbidly obese woman presents to a primary care clinic for the first time. She states that her father recently died due to kidney failure and wants to make sure she is healthy. She works as an accountant, is not married or sexually active, and drinks alcohol occasionally. She currently does not take any medications. She does not know if she snores at night but frequently feels fatigued. She denies any headaches but reports occasional visual difficulties driving at night. She further denies any blood in her urine or increased urinary frequency. She does not engage in any fitness program. She has her period every 2 months with heavy flows. Her initial vital signs reveal that her blood pressure is 180/100 mmHg and heart rate is 70/min. Her body weight is 150 kg (330 lb). On physical exam, the patient has droopy eyelids, a thick neck with a large tongue, no murmurs or clicks on cardiac auscultation, clear lungs, a soft nontender, albeit large abdomen, and palpable pulses in her distal extremities. She can walk without difficulty. A repeat measurement of her blood pressure shows 155/105 mmHg. Which among the following is part of the most appropriate next step in management?
- A. Renal artery doppler ultrasonography
- B. Polysomnography
- C. Urinalysis (Correct Answer)
- D. Thyroid-stimulating hormone
- E. Cortisol levels
Donor selection criteria Explanation: ***Urinalysis***
- Given the patient's strong family history of **kidney failure**, current presentation with **hypertension (BP 180/100 mmHg, confirmed at 155/105 mmHg)**, and concern for her health, a urinalysis is a crucial initial step to look for signs of kidney damage or disease.
- Urinalysis can detect **proteinuria**, **hematuria**, or other abnormalities indicative of renal pathology, helping to assess her kidney health.
*Renal artery doppler ultrasonography*
- While **renal artery stenosis** can cause hypertension, it is usually considered after initial non-invasive tests and if there are specific signs of secondary hypertension like a **renal bruit** or **unexplained renal insufficiency**, which are not explicitly described here as a first step.
- This is a more advanced diagnostic test and not typically the *most appropriate next step* before basic screening like urinalysis.
*Polysomnography*
- The patient's **morbid obesity**, **fatigue**, and physical exam findings like a **thick neck with a large tongue** suggest **obstructive sleep apnea (OSA)**, for which polysomnography is the diagnostic test.
- However, while important, addressing the immediate concern of **hypertension** and assessing **kidney health** (given the family history) is a higher priority in the *initial* workup.
*Thyroid-stimulating hormone*
- Symptoms like **fatigue**, **heavy menstrual periods (menorrhagia)**, and features like a **thick tongue** could suggest **hypothyroidism**.
- However, **hypertension** and the urgent need to evaluate **kidney function** (due to family history and current high blood pressure) make urinalysis a more immediate and critical step before an extensive endocrine workup.
*Cortisol levels*
- Elevated blood pressure, obesity, and menstrual irregularities could, in some contexts, raise suspicion for **Cushing's syndrome**.
- However, there are no classic features like **buffalo hump**, **moon facies**, or **striae** mentioned, and assessing renal involvement given the family history and current hypertension is a more direct next step.
Donor selection criteria US Medical PG Question 5: A 50-year-old man presents to a clinic with oliguria. Four weeks ago, he had a kidney transplant. Postoperative follow-up was normal. He is currently on cyclosporine and admits that sometimes he forgets to take his medication. On physical examination, the vital signs include: temperature 37.1°C (98.8°F), blood pressure 165/110 mm Hg, heart rate 80/min, and respiratory rate 16/min. There is mild tenderness on renal palpation. His serum creatinine level is 4 mg/dL, well above his baseline level after the transplant. Which of the following best describes the histological finding if a biopsy is taken from the transplanted kidney?
- A. Lymphocytic infiltration of graft vessels and endothelial damage (Correct Answer)
- B. Thrombosis and occlusion of vessels
- C. Atherosclerosis on angiography
- D. Necrosis with granulation tissue
- E. Thickening of blood vessels, fibrosis of graft vessels, and parenchymal atrophy
Donor selection criteria Explanation: ***Lymphocytic infiltration of graft vessels and endothelial damage***
- The patient's presentation with **oliguria**, elevated **creatinine**, and **hypertension** following a recent kidney transplant, especially with a history of non-adherence to **cyclosporine** (an immunosuppressant), strongly indicates **acute rejection**.
- Histologically, acute rejection is characterized by **lymphocytic infiltration** of the graft vessels (often referred to as **vasculitis** or **endotheliitis**) and associated **endothelial damage**.
*Thrombosis and occlusion of vessels*
- This finding is more characteristic of **hyperacute rejection**, which typically occurs within minutes to hours of transplantation, not weeks later.
- Hyperacute rejection is mediated by **pre-formed antibodies** and leads to severe, rapid graft failure due to widespread intravascular thrombosis.
*Atherosclerosis on angiography*
- While post-transplant patients can develop accelerated atherosclerosis (a form of **chronic rejection**), it is typically a long-term complication developing months to years after transplantation.
- The acute presentation with rapid creatinine elevation is not typical for primary atherosclerosis.
*Necrosis with granulation tissue*
- **Necrosis** with **granulation tissue** is a general healing response to significant tissue injury or inflammation.
- While some cellular necrosis can occur in severe rejection, it's not the defining feature, and granulation tissue indicates a more prolonged, subacute process rather than the primary histological hallmark of acute rejection.
*Thickening of blood vessels, fibrosis of graft vessels, and parenchymal atrophy*
- These are classic features of **chronic rejection**, which manifests months to years after transplantation as a gradual decline in graft function.
- **Chronic rejection** involves progressive damage leading to vasculopathy, interstitial fibrosis, and tubular atrophy, rather than the acute inflammatory cellular infiltrate seen here.
Donor selection criteria US Medical PG Question 6: A student health coordinator plans on leading a campus-wide HIV screening program that will be free for the entire undergraduate student body. The goal is to capture as many correct HIV diagnoses as possible with the fewest false positives. The coordinator consults with the hospital to see which tests are available to use for this program. Test A has a sensitivity of 0.92 and a specificity of 0.99. Test B has a sensitivity of 0.95 and a specificity of 0.96. Test C has a sensitivity of 0.98 and a specificity of 0.93. Which of the following testing schemes should the coordinator pursue?
- A. Test A on the entire student body followed by Test B on those who are positive
- B. Test A on the entire student body followed by Test C on those who are positive
- C. Test C on the entire student body followed by Test B on those who are positive
- D. Test C on the entire student body followed by Test A on those who are positive (Correct Answer)
- E. Test B on the entire student body followed by Test A on those who are positive
Donor selection criteria Explanation: ***Test C on the entire student body followed by Test A on those who are positive***
- To "capture as many correct HIV diagnoses as possible" (maximize true positives), the initial screening test should have the **highest sensitivity**. Test C has the highest sensitivity (0.98).
- To "capture as few false positives as possible" (maximize true negatives and confirm diagnoses), the confirmatory test should have the **highest specificity**. Test A has the highest specificity (0.99).
*Test A on the entire student body followed by Test B on those who are positive*
- Starting with Test A (sensitivity 0.92) would miss more true positive cases than starting with Test C (sensitivity 0.98), failing the goal of **capturing as many cases as possible**.
- Following with Test B (specificity 0.96) would result in more false positives than following with Test A (specificity 0.99).
*Test A on the entire student body followed by Test C on those who are positive*
- This scheme would miss many true positive cases initially due to Test A's lower sensitivity compared to Test C.
- Following with Test C would introduce more false positives than necessary, as it has a lower specificity (0.93) than Test A (0.99).
*Test C on the entire student body followed by Test B on those who are positive*
- While Test C is a good initial screen for its high sensitivity, following it with Test B (specificity 0.96) is less optimal than Test A (specificity 0.99) for minimizing false positives in the confirmation step.
- This combination would therefore yield more false positives in the confirmatory stage than using Test A.
*Test B on the entire student body followed by Test A on those who are positive*
- Test B has a sensitivity of 0.95, which is lower than Test C's sensitivity of 0.98, meaning it would miss more true positive cases at the initial screening stage.
- While Test A provides excellent specificity for confirmation, the initial screening step is suboptimal for the goal of capturing as many diagnoses as possible.
Donor selection criteria US Medical PG Question 7: A 27-year-old G1P0 female presents for her first prenatal visit. She is in a monogamous relationship with her husband, and has had two lifetime sexual partners. She has never had a blood transfusion and has never used injection drugs. Screening for which of the following infections is most appropriate to recommend this patient?
- A. Syphilis and HIV
- B. Syphilis, HIV, and HBV (Correct Answer)
- C. Syphilis, HIV, HBV, and chlamydia
- D. Syphilis, HIV, and chlamydia
- E. No routine screening is recommended for this patient
Donor selection criteria Explanation: ***Syphilis, HIV, and HBV***
- The **American College of Obstetricians and Gynecologists (ACOG)** and the **Centers for Disease Control and Prevention (CDC)** recommend universal screening for syphilis, HIV, and hepatitis B virus (HBV) in all pregnant women at the first prenatal visit.
- This **routine screening** is crucial due to the potential for vertical transmission and severe adverse outcomes for the neonate if untreated.
*Syphilis and HIV*
- While screening for syphilis and HIV is essential, it is **incomplete** as it omits HBV, which is also universally recommended for antenatal screening.
- This option does not align with the standard comprehensive screening guidelines for pregnancy.
*Syphilis, HIV, HBV, and chlamydia*
- Although syphilis, HIV, and HBV screening are appropriate, adding **chlamydia** to the universal prenatal screening for *all* pregnant women in the first trimester is not standard practice unless specific risk factors are present or local prevalence is high.
- Chlamydia screening is typically recommended for pregnant women who are **25 years or younger** or those with **risk factors** for sexually transmitted infections (STIs).
*Syphilis, HIV, and chlamydia*
- This option incorrectly includes chlamydia as a universal screen for all pregnant women while **omitting HBV**, which is universally recommended.
- Missing HBV screening leaves a critical gap in prenatal care, as it can be transmitted vertically and cause severe neonatal disease.
*No routine screening is recommended for this patient*
- This statement is incorrect as **universal screening** for syphilis, HIV, and HBV is recommended for all pregnant women, regardless of reported risk factors or monogamous relationships.
- Maternal infection can still occur, and screening helps prevent severe outcomes for both mother and child through timely detection and intervention.
Donor selection criteria US Medical PG Question 8: A 34-year-old man comes to the physician for a routine health maintenance examination. He was diagnosed with HIV 8 years ago. He is currently receiving triple antiretroviral therapy. He is sexually active and uses condoms consistently. He is planning a trip to Thailand with his partner to celebrate his 35th birthday in 6 weeks. His last tetanus and diphtheria booster was given 4 years ago. He received three vaccinations against hepatitis B 5 years ago. He had chickenpox as a child. Other immunization records are unknown. Vital signs are within normal limits. Cardiopulmonary examination shows no abnormalities. Leukocyte count shows 8,700/mm3, and CD4+ T-lymphocyte count is 480 cells/mm3 (Normal ≥ 500); anti-HBs is 150 mIU/mL. Which of the following recommendations is most appropriate at this time?
- A. Yellow fever vaccine
- B. Hepatitis B vaccine
- C. Tetanus, diphtheria, pertussis vaccine (Tdap)
- D. Measles, mumps, rubella vaccine
- E. No vaccination (Correct Answer)
Donor selection criteria Explanation: ***Correct: No vaccination***
- Given the patient's current immunization status and clinical scenario, **none of the listed vaccines are indicated at this time**.
- His CD4+ count of 480 cells/mm³ indicates relatively preserved immune function on effective antiretroviral therapy.
- His **anti-HBs level of 150 mIU/mL** demonstrates **adequate hepatitis B immunity** (protective level ≥10 mIU/mL).
- His **tetanus-diphtheria booster was given 4 years ago**, and routine boosters are recommended every **10 years**, so he is not due for another 6 years.
*Incorrect: Yellow fever vaccine*
- **Thailand is not a yellow fever endemic country**, so yellow fever vaccination is **not required or recommended** for travel there.
- Yellow fever vaccine is a **live attenuated vaccine** that can be given to HIV-positive patients with **CD4+ counts ≥200 cells/mm³** when travel to endemic areas (parts of Africa and South America) is necessary.
- Since the patient has a CD4+ count of 480 and Thailand doesn't require this vaccine, this is not applicable.
*Incorrect: Hepatitis B vaccine*
- The patient's **anti-HBs level of 150 mIU/mL** indicates **adequate protective immunity** against hepatitis B.
- A level ≥10 mIU/mL is considered protective, so **no booster is needed**.
*Incorrect: Tetanus, diphtheria, pertussis vaccine (Tdap)*
- **Tetanus-diphtheria boosters are recommended every 10 years**.
- The patient received his last booster **4 years ago**, so he is **not due** for another booster at this time.
- There is no specific indication for **pertussis vaccination** (e.g., pregnancy, close contact with infants).
*Incorrect: Measles, mumps, rubella vaccine*
- **MMR is a live attenuated vaccine** that is **contraindicated** in HIV-positive individuals with **CD4+ counts <200 cells/mm³**.
- While this patient's CD4+ count is 480, MMR should only be given to HIV patients if they lack immunity and have CD4 ≥200.
- There is **no documented need** for MMR based on the clinical scenario provided, and his immunity status to these infections is unknown.
- Without evidence of susceptibility or specific exposure risk, vaccination is not indicated.
Donor selection criteria US Medical PG Question 9: A 58-year-old man is brought to the emergency department because of confusion, weight loss, and anuria. He has chronic kidney disease, hypertension, and type 2 diabetes mellitus. He was diagnosed with acute lymphoblastic leukemia at the age of 8 years and was treated with an allogeneic stem cell transplantation. He is HIV-positive and has active hepatitis C virus infection. He drinks around 8 cans of beer every week. His current medications include tenofovir, emtricitabine, atazanavir, daclatasvir, sofosbuvir, insulin, amlodipine, and enalapril. He appears lethargic. His temperature is 36°C (96.8°F), pulse is 130/min, respirations are 26/min, and blood pressure is 145/90 mm Hg. Examination shows severe edema in his legs and generalized muscular weakness. Auscultation of the lung shows crepitant rales. Laboratory studies show positive HCV antibody and positive HCV RNA. His HIV viral load is undetectable and his CD4+ T-lymphocyte count is 589/μL. Six months ago, his CD4+ T-lymphocyte count was 618/μL. An ECG of the heart shows arrhythmia with frequent premature ventricular contractions. Arterial blood gas analysis on room air shows:
pH 7.23
PCO2 31 mm Hg
HCO3- 13 mEq/L
Base excess -12 mEq/L
The patient states he would like to donate organs or tissues in the case of his death. Which of the following is an absolute contraindication for organ donation in this patient?
- A. HIV infection
- B. Childhood leukemia (Correct Answer)
- C. Alcoholism
- D. No absolute contraindications
- E. Acute kidney injury
Donor selection criteria Explanation: ***Correct: Childhood leukemia***
- **History of hematologic malignancy** (including acute lymphoblastic leukemia) is an **absolute contraindication** for solid organ donation according to UNOS and OPTN guidelines.
- Even though this patient was treated 50 years ago with allogeneic stem cell transplantation, the concern for **residual malignant cells** or **transmission to immunosuppressed recipients** makes this an absolute exclusion.
- Unlike solid tumors (which may be acceptable after long disease-free intervals), **leukemias and lymphomas carry lifelong exclusion** from organ donation due to their systemic nature and potential for dormant cells.
*Incorrect: Acute kidney injury*
- **Acute kidney injury (AKI)** is NOT an absolute contraindication for organ donation.
- While the kidneys themselves may not be suitable for transplantation, other organs (heart, liver, lungs, corneas) could still be viable.
- Each organ is assessed individually for suitability.
*Incorrect: HIV infection*
- **Well-controlled HIV infection** (undetectable viral load, stable CD4 count >200) is no longer an absolute contraindication.
- Under the **HOPE Act (HIV Organ Policy Equity Act)**, organs from HIV-positive donors can be transplanted into HIV-positive recipients.
- This patient has excellent viral control (undetectable VL, CD4 589), making HIV not an absolute barrier.
*Incorrect: Alcoholism*
- **Alcohol use disorder** alone is not an absolute contraindication for organ donation.
- The suitability depends on individual organ assessment (e.g., liver function, cardiac health).
- This patient drinks 8 beers/week, which is moderate consumption and doesn't preclude donation of undamaged organs.
*Incorrect: No absolute contraindications*
- This patient **does have an absolute contraindication**: his history of hematologic malignancy (acute lymphoblastic leukemia).
- Despite the long time since treatment, hematologic cancers remain absolute exclusions for organ donation.
Donor selection criteria US Medical PG Question 10: A 38-year-old kidney transplant recipient maintained on tacrolimus presents with a 2-week history of progressive confusion, ataxia, and visual disturbances. MRI shows multifocal white matter lesions without mass effect or enhancement. CSF analysis reveals mild pleocytosis with elevated protein. JC virus DNA is detected in CSF by PCR. Serum tacrolimus level is therapeutic at 8 ng/mL. Apply knowledge of this condition to determine the appropriate management strategy.
- A. Significantly reduce or discontinue immunosuppression and provide supportive care (Correct Answer)
- B. Switch from tacrolimus to sirolimus to preserve graft while treating infection
- C. Continue current immunosuppression and administer IVIG therapy
- D. Maintain immunosuppression and start cidofovir antiviral therapy
- E. Reduce tacrolimus by 50% and start high-dose corticosteroids
Donor selection criteria Explanation: ***Significantly reduce or discontinue immunosuppression and provide supportive care***
- The patient presents with **Progressive Multifocal Leukoencephalopathy (PML)** caused by **JC virus** reactivation; the primary treatment is **immune reconstitution** to allow the body to fight the virus.
- Reducing or stopping agents like **tacrolimus** is critical for survival, even though it carries a high risk of **allograft rejection**.
*Switch from tacrolimus to sirolimus to preserve graft while treating infection*
- While **sirolimus** has some antiproliferative effects, it is still an **immunosuppressant** and will not allow for the aggressive immune recovery needed to halt **JC virus** replication.
- Managing the life-threatening neurological condition takes precedence over **graft preservation** in the acute phase of PML.
*Continue current immunosuppression and administer IVIG therapy*
- Maintaining current levels of **tacrolimus** prevents the T-cell mediated response necessary to clear the **JC virus** from the CNS.
- **IVIG therapy** has not been proven effective in clinical trials for the treatment of PML and does not address the underlying **immunosuppressed state**.
*Maintain immunosuppression and start cidofovir antiviral therapy*
- **Cidofovir** was previously studied for PML, but it has failed to show significant clinical benefit and is associated with severe **nephrotoxicity**.
- Antiviral therapy without addressing the **cellular immune deficiency** is insufficient to treat this opportunistic infection.
*Reduce tacrolimus by 50% and start high-dose corticosteroids*
- Adding **high-dose corticosteroids** is contraindicated as it further suppresses the immune system, potentially accelerating the progression of **PML**.
- Steroids are typically reserved only for patients who develop **Immune Reconstitution Inflammatory Syndrome (IRIS)** after immunosuppression is withdrawn.
More Donor selection criteria US Medical PG questions available in the OnCourse app. Practice MCQs, flashcards, and get detailed explanations.
