Clinical Microbiology Manual: Organ Donation

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Questions and Answers

What is the primary responsibility of the Specialist Nurse (SN) regarding clinical microbiological screening?

  • Performing the microbiological tests in the lab.
  • Ensuring appropriate tests are requested according to the agreed protocol. (correct)
  • Interpreting test results and providing clinical advice.
  • Developing new microbiological screening protocols.

When is BBV NAT testing indicated according to the manual?

  • For individuals where behavioural and sexual history is considered high risk. (correct)
  • Only when a patient has symptoms of a bloodborne virus.
  • For all organ and tissue donors as a mandatory screening step.
  • When requested by the transplant team, regardless of risk factors.

What action should be taken if, during the characterization or donation process in England, Wales, or Northern Ireland, a positive virology result is obtained, but BBV NAT has not been triggered?

  • The SN should proceed with the donation as planned.
  • The SN must notify MSL Virology via email to process BBV NAT testing on the HEV Sample. (correct)
  • An additional sample is required.
  • The case should be immediately escalated to the national transplant team.

According to the manual, what is the correct procedure for handling indeterminate microbiology results?

<p>Enter them as 'INDETERMINATE' into DonorPath and await further instruction. (A)</p> Signup and view all the answers

If offering has been commenced prior to microbiology results being available, what action should be taken according to the manual?

<p>Contact HUB operations to inform them of changes. (B)</p> Signup and view all the answers

When reviewing final microbiology, including new negative results, what is the next step?

<p>The SN must contact ODT Hub operations to review organ outcome summary. (B)</p> Signup and view all the answers

According to the manual, in the event of positive microbiology/virology results, excluding CMV, EBV, and Toxo, what is the next step for the SN?

<p>The SN contacts OLN/OM On Call to be advised if appropriate to seek specialist advice. (B)</p> Signup and view all the answers

According to the manual, what is the primary goal of performing clinical microbiology in deceased organ donors?

<p>To manage the risk of infection transmission through transplanted organs/tissue. (B)</p> Signup and view all the answers

What does the Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO) Guidance provide in the context of organ donation?

<p>Advice on suitability and potential contraindications to organ/tissue donation. (D)</p> Signup and view all the answers

What does a positive IgG to Hepatitis B surface antigen (anti-HBsAg) potentially indicate?

<p>Either successful immunisation or previous infection with the virus. (A)</p> Signup and view all the answers

According to the document, why is it important to note a recent risk when interpreting false negative results?

<p>To identify infections during the window period where antibody or antigen levels are insufficient for detection. (B)</p> Signup and view all the answers

According to the manual, which of the following actions should be taken when confirming organ outcomes with Hub Ops?

<p>Confirm if the pancreas was isolated and where, for inclusion of the isolating lab. (B)</p> Signup and view all the answers

When should the Specialist Nurse (SN) consult the Microbiology Screening Table (Appendix 1)?

<p>Upon receiving positive or indeterminate clinical microbiology results. (B)</p> Signup and view all the answers

Within the confines of SN responsibility, as mentioned in the text, when MUST the SN discuss with OLNor OM On Call?

<p>If they have general concerns or require clarity regarding the Microbiology results (B)</p> Signup and view all the answers

If new samples have been requested, according to the text, what must the SN email to the MSL/SNBTS?

<p>a complete rational for additional testing requirement. (D)</p> Signup and view all the answers

If it is identified that a patient is within 28 days of travel from a high risk area has occurred during Mosquito season, what must happen?

<p>Testing is indicated (C)</p> Signup and view all the answers

In the event it is not possible to be 100% sure if the sample is positive or negative for a particular marker, what happens?

<p>Indeterminate results occur and final results may or may not be available before donation and transplantation takes place (D)</p> Signup and view all the answers

In the instance of low blood volume, or haemodilution, what is one course of action that can be taken?

<p>perform haemodilution calculation (C)</p> Signup and view all the answers

For patients under 18 months, or recently breast-fed in the last 12, what sample must be collected?

<p>relevant microbiological samples from the mother (C)</p> Signup and view all the answers

Which of the following details must always be included in the subject line of an email concerning new microbiology information?

<p>ORGAN DONOR: NEW INFORMATION Test Name (mark as High Priority) (C)</p> Signup and view all the answers

What is the correct action to be taken by the SN upon reviewing a report following a confirmed negative Hepatitis A/parvovirus result?

<p>The SNBTS will send a negative result to the DFCS who will upload the result and alert POC. (C)</p> Signup and view all the answers

According to the document, before arranging discussions with the donor family on positive clinical microbiological findings, what MUST be planned with the LN and OM?

<p>interpret the result with a clinical microbiologist to establish if current/past infection (B)</p> Signup and view all the answers

In what instance could additional testing be needed due to low blood volume and a resulting reduction in blood quality?

<p>SN isn't aware of large volume blood loss requiring intravenous fluid replacement therapy (B)</p> Signup and view all the answers

In the event that malaria or T Cruzi is identified after the GDRI check, which document should be followed for further testing criteria?

<p>TDSG-DD General Principles (D)</p> Signup and view all the answers

In what circumstances does the manual suggest informing the NOK/donor family in organ donation cases?

<p>If there's urgency for family members with potential risks. (B)</p> Signup and view all the answers

What does the manual say that immunisation will also induce, meaning?

<p>a positive IgG to Hepatitis B surface antigen (A)</p> Signup and view all the answers

What does it mean if a test returns a false-positive result?

<p>cross-reaction between different antigens and antibodies, i.e. proteins that look similar (B)</p> Signup and view all the answers

What does a HBV vaccine contain?

<p>HBV surface antigen (D)</p> Signup and view all the answers

Which information is mentioned in the document as important to identify malaria?

<p>Geographical location where a person may have been infected and how sick they are when treatment commences. (C)</p> Signup and view all the answers

Flashcards

Specialist Nurse (SN) Responsibilities

SNs must understand the rationale and importance of clinical microbiological screening, and ensure appropriate tests are requested according to protocol.

TES CSNT Responsibilities

The Tissue and Eye Services Clinical Support Nurse Team (TES CSNT) must understand the rationale and importance of clinical microbiological screening.

Clinical Microbiology screening

Assess whether the person has been infected with a transmissible agent and whether that agent is still actively replicating.

Antigen

Part of the infectious agent that provokes an immune response from the body.

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Antibody

Shows that the body has recognized an antigen, indicating that infection has taken place.

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IgM and IgG

Following a new infection, the body makes IgM antibody then IgG antibody; so, the presence of IgM usually implies recent infection.

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RNA + DNA

Shows current infection (whether DNA or RNA depends on the agent) This can be detected by Nucleic Acid Tests (NAT) with Polymerase Chain Reaction (PCR) being one such test.

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Geographical Disease Risk Index (GDRI)

Used to search for each individual country to identify potential requirements for additional testing. SN must identify location of travel, duration of travel and date of return to the UK.

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BBV NAT

BBV NAT testing is indicated for individuals where behavioural and sexual history is considered high risk

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Recording Provisional Positive Results

A provisional positive or initial reactive result must be entered into DonorPath as a positive result until the confirmatory testing has been complete. Follow SOP3925 if unable to record on DonorPath.

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Immediate Actions for Results

For tests with positive or indeterminate results, consult Appendix 1.

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HHV-8 Result Reporting

A positive or Indeterminate/Inconclusive result will mean the MSL are responsible for reporting results to OTDT, this will take place post donation.

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Negative Hepatitis A and Parvovirus B19 Result

A confirmed negative result will be available within 24-48 hour's (excluding weekend). SNBTS will send a negative result to the DFCS who will upload the result and will alert POC.

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Positive Hepatitis A and Parvovirus B19 Result

An initial reactive positive result will be emailed/phoned through to Hub Operations who will then page/email the SN team, the POC/SN will be required to upload this onto Donor Path and action as per page 2.

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Communication with NOK/Donor Family

SNs must use their professional judgement and knowledge of the donor and family's circumstances, to decide on the most appropriate course of action for communicating results.

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GDRI check

Used to search for each individual country to identify potential requirement for additional testing. SN must identify location of travel, duration of travel and date of return to the UK.

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Confirm pancreas isolation.

The SN should confirm if the pancreas was isolated and where so that the isolating lab can be included in dissemination of the micro results report.

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Study Notes

Clinical Microbiology Manual Overview

  • SOP6514/6 is the reference document, titled Clinical Microbiology Manual, effective from 26FEB2025.
  • The manual provides guidance for Organ Donation Services Teams to minimize infection risks to organ recipients and maximize organ/tissue safety.

Responsibilities

  • Specialist Nurses (SNs) must understand clinical microbiological screening rationale.
  • SNs are responsible for requesting appropriate tests per protocol and ensuring results reach retrieval/recipient teams; not to interpret results.
  • Tissue and Eye Services - Clinical Support Nurse Teams must understand clinical microbiological screening importance.
  • The TES CSNT should seek support from experts for communication received following a letter.

Summary of changes

  • Pages 34 and 35 contain lab result interpretations for Hepatitis A and Parvovirus B19.
  • Updated interim results visibility on donor/transplant paths for all microbiology results, including HHV8, on pages 29-30.
  • Page 31 covers confirmation of organ outcomes with Hub Ops, SN should confirm the pancreas isolation details for micro results dissemination.
  • BBV/NAT testing and results process is standardized on page 16.
  • TxP stands for Transplant Path.
  • OM On Call is the Operational Manager (e.g., Regional Head of Nursing).

Purpose and Objective

  • Transplantation is a treatment for end-stage organ failure but carries infection risks.
  • Comprehensive patient assessment of potential organ/tissue donors is needed to manage infection risks.
  • SNs need to obtain detailed medical, behavioural, and travel histories along with clinical microbiological testing of potential donors.
  • Quality and Safety of Organs Intended for Transplantation Regulations (2012) says minimum data should be available to support decision making in accepting an organ for transplant.

Terminology

  • Laboratories test blood (or other) samples for antibodies or actual pathogens (antigen or nucleic acid).
  • "Antigen" refers to a part of an infectious agent that causes an immune response.
  • "Antibody" indicates the body has recognized an antigen, suggesting an infection occurred.
  • IgM and IgG antibodies, where first IgM then IgG appear after a new infection, IgM indicates a recent infection.
  • Immunization leads to an antibody response, so a positive IgG to Hepatitis B surface antigen (anti-HBsAg) can indicate immunization or past infection.
  • RNA + DNA: indicate current infections (depending on the agent), detectable via Nucleic Acid Tests (NAT) like Polymerase Chain Reaction (PCR).

Diagnostic Blood Tests

  • SN ensures appropriate tests during characterisation phase according to the protocol
  • Universal Blood Tests for ALL Donors: hepatitis B surface antigen, hepatitis B Core Antibody, hepatitis C Virus Antibody, Human Immunodeficiency Virus 1 + 2, Cytomegalovirus, Epstein Barr Virus, etc.

Additional Blood Tests

  • SN must identify any high-risk factors from medical notes, GP history, or MaSH questionnaire.
  • E, W & NI: If high-risk factors are identified then BBV NAT section is indicated.

Post Donation Result

  • Check PID against donor record. Check against individual pre-donation result documented on DonorPath against final microbiology report.

Post Donation

  • SN must contact recipients and transplanting centres to alert them of confirmed microbiology results.

Contacting the laboratories

  • MSL Virology in Colindale is the reference laboratory for England, Northern Ireland and Wales
  • SNBTS is the reference laboratory for Scotland.

DonorPath

  • Electronic database for donor information and results.

DCERT Project

  • Managing Clinical Microbiology results at the time of donation if laboratory is NOT in the Donor Characterisation Electronic Results Transfer project or if DCERT system is down.
  • If laboratory is in the Donor Characterisation Electronic Results Transfer (DCERT) project.

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