Solid Organ Transplantation: Evaluation Process and Listing Criteria

Vocabulary flashcards covering solid organ transplant evaluation, allocation algorithms, urgency categories, diagnostic assessments, and listing criteria for heart, lung, and liver candidates.

Heart Allocation Basis (US and Canada)

The system used in the United States and Canada to allocate donor hearts based on severity of disease and medical urgency.

Lung Transplantation Indication

End-stage pulmonary disease in patients who are sick enough to need a transplant but well enough to survive the surgical procedure.

Common Indications for Lung Transplantation

Non α-1 antitrypsin disease, chronic obstructive pulmonary disease (COPD), interstitial lung disease, bronchiectasis associated with cystic fibrosis, pulmonary hypertension, and COPD associated with α-1 antitrypsin disease.

Lung Volume Reduction Surgery

A surgical alternative to lung transplantation for select patients with emphysema, determined by pulmonary function testing, a $6\text{-minute}$ walk test, quantitative ventilation/perfusion scanning, and oxygen requirements.

Thoracic CT Scan (Lung Evaluation)

Contrast-enhanced computed tomography scanning performed to delineate thoracic anatomy, detect surgical barriers, and characterize pulmonary pathology.

Status 7 (US Heart Allocation)

A medical urgency status for adult and pediatric heart candidates who are temporarily on hold and not currently accumulating waitlist time.

Status 2 (US Heart Allocation)

A heart allocation category for adult candidates waiting at home who do not meet higher urgency criteria, or pediatric candidates waiting at home who do not qualify for Status 1A or 1B.

Status 1B (US Heart Allocation)

A listing urgency tier for adult heart candidates supported by a VAD or IV inotropes at home or in the hospital, or TAH at home; and pediatric candidates on inotropes not meeting Status 1A, or aged $< 1\text{ y}$ with hypertrophic or restrictive cardiomyopathy.

Status 1A (US Heart Allocation)

A high-urgency tier for adult heart candidates in the ICU on high-dose inotropic therapy with hemodynamic monitoring, on an IABP, on mechanical ventilation, using $30\text{ d}$ of VAD/TAH time, or with mechanical device complications; and pediatric patients on mechanical ventilation, IABP, or assist devices.

Status 4S (Canada Heart Allocation)

A Canadian heart allocation category for adult candidates with panel reactive antibody (PRA) $> 80\%$ or PRA $> 20\%$ with three prior positive crossmatches; or pediatric candidates with PRA $> 80\%$ or three prior positive crossmatches.

Ventilation/Perfusion (V/Q) Scan

A diagnostic nuclear medicine scan that quantifies the percentage of ventilation and perfusion contributed by each lung to detect inequality and determine which lung to replace in single lung transplantation.

Six-Minute Walk Test

A functional evaluation where a patient walks at their own pace for $6\text{ minutes}$ (stopping as needed) to assess functional impairment, exercise tolerance, rehabilitation potential, dyspnea, and supplemental oxygen requirements.

Continuous Ambulatory pH Monitoring

An assessment of severe gastroesophageal reflux disease used in pre-lung transplant workups to determine the need for medical or surgical antireflux intervention to prevent allograft infections.

Lung Allocation Score (LAS)

An algorithm implemented by UNOS in 2005 that assigns donor lungs based on recipient medical urgency rather than waiting list seniority; updated every $6\text{ months}$.

Simultaneous Heart/Lung Transplantation

A combined organ transplant indicated for concurrent end-stage heart and lung disease or severe, fixed pulmonary hypertension, currently performed fewer than $100$ times per year worldwide.

Eisenmenger Syndrome

A congenital cardiac anomaly characterized by severe pulmonary hypertension secondary to chronic systemic-to-pulmonary shunting and cyanosis; the most common indication for adult heart/lung transplantation.

Liver Transplantation Indication

Severe, acute, or advanced chronic liver failure refractory to medical therapy, or curative management for specific non-failing metabolic disorders such as primary hyperoxaluria, familial amyloidosis, and polyneuropathy.

α-Fetoprotein (AFP)

A serum tumor marker evaluated during the liver transplant evaluation process to detect and monitor hepatocellular carcinoma (HCC).

Carbohydrate Antigen 19-9 (CA 19-9)

A serum tumor marker evaluated during liver transplant workups to screen for cholangiocarcinoma.

Pre-Transplant Liver Biopsy

A non-routine pathologic procedure performed selectively during liver transplant evaluation to identify or stage hepatocellular carcinoma (HCC) or determine an unconfirmed underlying hepatic etiology.

Abdominal Ultrasound with Doppler Imaging

A pre-liver transplant imaging examination performed to assess patency of the portal vein and exclude hepatocellular carcinoma (HCC).

Complications of Chronic Liver Failure

Pathologic sequelae of decompensated liver disease, including ascites, encephalopathy, hepatocellular carcinoma, refractory variceal hemorrhage, synthetic dysfunction, and chronic GI bleeding from portal hypertensive gastropathy.