Training activity information
Details
Perform local laboratory methods for crossmatching donors and recipients for solid organ transplantation
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Considerations
- Principles of laboratory methods for crossmatching donors and recipients for solid organ transplantation
- Internal quality controls and external quality assessment measures
- Method limitations, including cellular/microbiological contamination, false negative and positive reactions, low/high cell yield, poor viability of cells and drug interactions
- Infection control
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
What does success look like?
- Identify what is expected of you in relation to successfully performing local laboratory crossmatching methods for solid organ transplant (e.g., complement dependent cytotoxicity / flow cytometry crossmatch).
- Consider how the learning outcomes apply, specifically in relation to performing the relevant laboratory investigations and practicing in accordance with quality standards.
- Discuss with your training officer to gain clarity of what is expected of you in relation to cell viability requirements, reagent quality checks, ensuring accurate mixing/incubation, and performing both negative and positive controls correctly.
What is your prior experience of this activity?
- Think about what you already know about cell-based assays, pipetting precision, and the visual or instrument-based determination of cell death or binding.
- Consider possible challenges you might face during the activity, such as low donor cell viability, contamination, unexpected control failures (e.g., auto-control positive), or technical difficulties with flow cytometry acquisition.
- Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example if the positive control fails or the donor cell viability is too low to proceed, compromising the validity of the critical pre-transplant test.
- Acknowledge how you feel about performing a time-sensitive, high-stakes assay that directly precedes transplantation.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as mastering cell-handling techniques to maximise viability or efficient troubleshooting of assay anomalies.
- Identify the specific insights you hope to gain into the practical differences and limitations between different crossmatch methodologies (e.g., CDC vs Flow).
What additional considerations do you need to make?
- Consult actions identified following previous experiences of running cell-based assays or dealing with complex reagents.
- Identify important information you need to consider before embarking on the activity, such as reviewing the specific local protocol steps, verifying the status of donor lymphocytes (e.g., time since isolation), and confirming the working solution quality of complement or fluorescent reagents.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst performing the crossmatch assay?
- Are you encountering situations such as:
- Unexpected results in controls e.g., negative controls showing reactivity, positive controls failing or unexpected reactivity patterns e.g., weak or ambiguous signal in the test wells?
- Issues arising with donor cell viability or contamination that compromise the assay performance?
- Technical difficulties with equipment e.g., flow cytometer acquisition failure, temperature variance during incubation?
How are you reacting to the unexpected development?
- How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to troubleshooting or technique?
- Consider the steps you are taking in the moment, such as:
- Immediately verifying control results or checking reagents/cells if unexpected reactivity occurs
- Seeking a second opinion on difficult visual interpretations e.g., in Complement Dependent Cytotoxicity crossmatch
- How are you feeling in that moment? For instance, are you finding it difficult to troubleshoot a time-sensitive issue with the donor cells? Is it affecting your confidence in performing the crossmatch assay independently and reliably?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully resolving a minor control issue through standard troubleshooting steps? Or are you needing support because unresolvable low donor cell viability requires senior consultation on whether the result can be released?
- What are you learning as a result of the unexpected development? For example, are you mastering advanced cell handling techniques to maximise donor cell viability? Or gaining insight into the factors that cause false positive or negative crossmatch results?
On action
What happened?
- Begin by summarising the key steps you took when performing the crossmatching method(s) for solid organ transplantation.
- Consider specific events, actions, or interactions which felt important, such as how you prepared donor lymphocytes, added serum/complement/reagents, and utilised the flow cytometer or microscope.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately pausing the assay when the positive control failed or adjusting the washing steps when non-specific background was observed.
- How did you feel during this experience, e.g., did you feel time-pressured but precise or anxious about control failures?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding performing crossmatching methods. What strengths did you demonstrate, e.g., technical precision in cell handling?
- What skills and/or knowledge gaps were evident, e.g., troubleshooting complex flow cytometer issues or managing low donor cell viability?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in performing the relevant laboratory investigations?
- Identify any challenges you experienced, such as low donor cell viability, control failure, or needing advice on scope of practice regarding whether to proceed with a compromised run, and how you reacted to this.
What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to improving your proficiency with crossmatching methods.
- What will you do differently next time you approach performing a crossmatch, for instance, by proactively checking the integrity of the donor cell suspension immediately prior to starting the assay?
- Do you need to practise any aspect of the activity further, such as flow cytometer operation or key learning outcomes related to practicing in accordance with quality standards?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of performing crossmatching for solid organ transplantation since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how a subsequent run failure due to low donor cell viability forced you to re-evaluate the diligence of your initial cell handling and viability checks during your first attempt at this training activity.
- Considering what you understand about cell handling, crossmatch methodologies (e.g., CDC, flow cytometry), and the critical nature of the assay now, were the actions or considerations you identified after your initial reflection on this training activity sufficient?
- How have you since implemented or adapted improvements in your cell handling technique or troubleshooting protocols based on further learning and experiences? For example, how you proactively reviewed and implemented a standardised checklist for flow cytometer calibration before starting the crossmatch based on further learning.
- Has discussing different crossmatch methodologies or best practices for achieving reliable and interpretable results with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a case where a false positive result caused by poor cell quality led to unnecessary delays refined your understanding of the critical nature of technical precision under pressure during this urgent assay.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent experiences of performing crossmatches, contributed to your overall confidence and competence in executing crossmatch assays reliably, particularly in preparing for observed assessments (DOPS or OCEs) such as ‘Perform tests for donor recipient crossmatching’? For example, how your accumulated ability in precise laboratory technique and troubleshooting now enables you to manage technical challenges confidently during a DOPS assessment.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to crossmatch performance?
- How does this evolved understanding help you identify when a crossmatch run has failed or produced ambiguous results and when this requires urgent expert review? For example, how your evolved approach means you now routinely seek urgent expert review immediately when low donor cell viability compromises the validity of the pre-transplant test, recognising this falls outside routine technical scope.
- Looking holistically at your training journey, how has this initial crossmatch performance experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to performing relevant investigations and practicing in accordance with quality standards? For example, how this foundational experience has supported your development in transferable skills such as working under pressure and understanding of cellular immunity that will be valuable in future roles or responsibilities.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 3 |
Outcome
Perform the relevant laboratory investigations for a range of patients referred to an H&I laboratory. |
| # 6 |
Outcome
Practice in accordance with quality and accreditation standards. |