Module - Solid Organ Transplantation (SLS143)

STP

Aim of this module

This module will provide the trainee with knowledge and understanding of the mechanism of hypersensitivity and allergy. They will understand the clinical presentation and investigation of a range of conditions associated with hypersensitivity and allergy. They will become familiar with methods and strategies to investigate hypersensitivity and allergy and gain experience of the interpretation of patient results in a variety of clinical settings.

This module will provide the trainee with the practical application of knowledge and skills relating to Histocompatibility and Immunogenetics techniques applicable to solid organ transplantation and blood transfusion.

Work-based learning outcomes


  1. Perform the clinical and laboratory work up of patients awaiting solid organ transplantation, including the interpretation and reporting of results in the correct clinical context.
  2. Assess the suitability of patients for crossmatch and transplantation within the national deceased donor organ allocation scheme.
  3. Analyse and report laboratory tests for donor and recipient compatibility to facilitate transplantation within the national deceased donor organ allocation scheme.
  4. Assess the suitability of patients for crossmatch and transplantation for living donation.
  5. Perform clinical and laboratory monitoring of patients who have received a solid organ transplant.
  6. Work in partnership with other clinical specialisms in the investigation of solid organ transplantation and platelet transfusion and, where appropriate with service users and support staff.
  7. Assess the suitability of patients for HLA/HPA selected platelets and identify compatible platelet units.

Work-based Competencies


Learning outcome Title Knowledge
1 1

Assess patients for registration onto the national transplant list and perform the tests necessary to achieve this including:

  • HLA typing
  • HLA antibody detection/definition
  • How to assure the quality of personal practice.
  • Local protocols for the clinical and laboratory work up of patients awaiting solid organ transplantation including:
    • kidney transplantation
    • other organs as appropriate to the laboratory.
  • National requirements for transplant patient registration
    • HLA type
    • HLA antibody profile
    • ABO blood group
    • Sensitisation history
    • Policy for registration of unacceptable antigens.
2 1,2,4,5

Interpret data from HLA antibody identification tests and prepare clinically meaningful reports on patients awaiting solid organ transplantation.

  • How to assure the quality of personal practice.
  • Current molecular HLA nomenclature.
  • HLA antibody specificity nomenclature.
  • Correct use of manual and computerised systems for interpreting and entering laboratory results.
  • The need to manage records and all other information in accordance with applicable legislation, protocols and guidelines.
3 1,2,3,4,7

Interpret crossmatch data and produce a crossmatch report for clinical colleagues according to local protocol.

  • How to assure the quality of personal practice.
  • Correct use of data in relation to the full range of investigations specified within this module.
  • Requirements of reports including sources of information, appropriate use of patient records, reference materials and current National/International Guidelines.
  • The need to manage records and all other information in accordance with applicable legislation, protocols and guidelines.
4 2,3

HLA type a deceased potential donor according to local protocols and complete a donor HLA report form for submission to NHSBT-ODT.

  • How to assure the quality of personal practice.
  • Interpretation of HLA typing data.
  • Current HLA nomenclature.
  • Requirements for ODT reporting of HLA typing results.
5 2,3

Assess the suitability of potential kidney/pancreas recipients for a deceased donor organ.

  • Current National and International guidelines for solid organ allocation and transplantation.
  • The need to manage records and all other information in accordance with applicable legislation, protocols and guidelines.
  • NHSBT-ODT algorithm for deceased donor organ allocation.
    • HLA match
    • ABO blood group compatibility
    • HLA antibody compatibility
    • Other criteria affecting allocation
  • National guidelines for risk assessment of cardiothoracic and other organ recipients.
  • Local criteria for cross-match suitability.
  • Local policy for virtual cross-match suitability.
  • Clinical interpretation of cross-match results, in relation to HLA antibody testing.
6 2,3

Assess the suitability of potential cardio thoracic or other solid organ (liver, islets, bowel) recipients for a deceased donor.

  • Current National and International guidelines for solid organ allocation and transplantation.
  • The need to manage records and all other information in accordance with applicable legislation, protocols and guidelines.
  • NHSBT-ODT algorithm for deceased donor organ allocation.
    • HLA match
    • ABO blood group compatibility
    • HLA antibody compatibility
    • Other criteria affecting allocation
  • National guidelines for risk assessment of cardiothoracic and other organ recipients.
  • Local criteria for cross-match suitability.
  • Local policy for virtual cross-match suitability.
  • Clinical interpretation of cross-match results, in relation to HLA antibody testing.
7 2,3,4,7

Analyse crossmatch data for a potential transplant recipient according to local policy and prepare a crossmatch report for clinical colleagues.

  • Current National and International guidelines for solid organ allocation and transplantation.
  • The need to manage records and all other information in accordance with applicable legislation, protocols and guidelines.
  • NHSBT-ODT algorithm for deceased donor organ allocation.
    • HLA match
    • ABO blood group compatibility
    • HLA antibody compatibility
    • Other criteria affecting allocation
  • National guidelines for risk assessment of cardiothoracic and other organ recipients.
  • Local criteria for cross-match suitability.
  • Local policy for virtual cross-match suitability.
  • Clinical interpretation of cross-match results, in relation to HLA antibody testing.
8 2,3,4,7

Perform a virtual crossmatch assessment for a potential transplant recipient according to local policy and prepare a cross-match report for clinical colleagues.

  • Current National and International guidelines for solid organ allocation and transplantation.
  • The need to manage records and all other information in accordance with applicable legislation, protocols and guidelines.
  • NHSBT-ODT algorithm for deceased donor organ allocation.
    • HLA match
    • ABO blood group compatibility
    • HLA antibody compatibility
    • Other criteria affecting allocation
  • National guidelines for risk assessment of cardiothoracic and other organ recipients.
  • Local criteria for cross-match suitability.
  • Local policy for virtual cross-match suitability.
  • Clinical interpretation of cross-match results, in relation to HLA antibody testing.
9 2,3,4,7

Assess the suitability of potential kidney donor/recipients for a living donor transplant and produce an interpretive report for clinical colleagues.

  • Current legislation for living donor transplantation
    • Human Tissue Act
    • Directed and non-directed donation
    • NLDKSS
  • Strategies to improve access to transplantation for sensitised   patients, including
    • Antibody removal
    • ABOi and HLA antibody incompatible (HLAi) transplantation
    • Epitope matching
10 5

Perform tests to detect or monitor donor specific antibodies for post transplant patients.

  • How to assure the quality of personal practice.
  • Local protocols for the clinical and laboratory monitoring of patients who have received solid organ transplantation
    • ABOi/HLAi transplants
    • Donor Specific Antibody (DSA) monitoring
  • Post transplant complications including:
    • Graft rejection (hyperacute, accelerated, acute, chronic)
    • Immunosuppression (IS) regimens.
11 6

Work in partnership with other clinical specialisms in the investigation of solid organ transplantation and platelet transfusion and, where appropriate with service users and support staff.

  • The need to build and sustain professional relationships as both an independent practitioner and collaboratively as a member of a team.
  • Methods of effective communication.
  • How communication skills affect assessment of, and engagement with, service users and how the means of communication should be modified to address and take account of factors such as age, capacity, learning ability and physical ability.
  • Situations where it is necessary to share information to safeguard service users or the wider public.
12 6

Communicate effectively with the healthcare team recognising and responding appropriately to situations where it is necessary to share information to safeguard service users or the wider public.

  • The need to build and sustain professional relationships as both an independent practitioner and collaboratively as a member of a team.
  • Methods of effective communication.
  • How communication skills affect assessment of, and engagement with, service users and how the means of communication should be modified to address and take account of factors such as age, capacity, learning ability and physical ability.
  • Situations where it is necessary to share information to safeguard service users or the wider public.
13 7

Analyse antibody data for a patient referred for platelet refractoriness and produce an interpretive report for clinical colleagues

  • How to assure the quality of personal practice.
  • Local protocols for the selection of HLA and / or Human Platelet Antigen (HPA) compatible platelets.
  • Indications for platelet transfusion, e.g.
    • Immune and non-immune causes of platelet refractoriness
  • Matching algorithms
    • Pre and post transfusion monitoring
14 7

Select appropriate platelet units for patients requiring HLA/Human Platelet Antigen (HPA) selected platelets

  • How to assure the quality of personal practice.
  • Local protocols for the selection of HLA and / or Human Platelet Antigen (HPA) compatible platelets.
  • Indications for platelet transfusion, e.g.
    • Immune and non-immune causes of platelet refractoriness
  • Matching algorithms
    • Pre and post transfusion monitoring

Work-based assessment


Complete 2 Case-Based Discussion(s)
Complete 2 of the following DOPS and/or OCEs
Type Title
DOPS Perform tests for deceased donor recipient crossmatching
DOPS Perform tests for living donor recipient crossmatching
DOPS Prepare a prospective or retrospective crossmatch report
DOPS Perform tests to monitor post-transplant donor specific antibodies
DOPS Perform a virtual crossmatch for deceased or living donation
DOPS HLA type a potential deceased donor
DOPS Prepare a living donor assessment report
DOPS Perform a risk assessment for cardiothoracic donation according to UK guidelines
DOPS Prepare a platelet refractoriness assessment report
DOPS Identify compatible HLA selected platelet units
OCE Attend ward rounds and/or clinics at which patients are being worked up for, or monitored following solid organ transplantation and describe to the patient the involvement of the Laboratory in their care
OCE Attend a living donor transplant
OCE Attend a multidisciplinary review meeting at which laboratory results are presented.