Advanced H&I – Solid Organ Transplantation and Transfusion —
Training activity: 3

Details

Interpret information included on an ODT deceased donor solid organ matching run

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

• Local process and procedures for confirming suitability
• ODT organ offering policies
• Patient antibody screening history
• Patient sensitisation history
• Local policies

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 accurately interpreting information included on an ODT deceased donor solid organ matching run according to relevant guidelines and policies.
• Consider how the learning outcomes apply, specifically in relation to performing appropriate testing, interpreting and reporting tests, assessing suitability, practicing according to standards, and practicing effectively in partnership.
• Discuss with your training officer to gain clarity of what is expected of you in relation to what the key data points to extract and understand from the matching run results are.

What is your prior experience of this activity?

• Think about what you already know about reviewing matching run data before, perhaps for other types of transplants or using different systems.
• Consider possible challenges you might face during the activity, such as understanding complex algorithms, interpreting HLA mismatches, or dealing with the urgency of deceased donor offers.
• 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 an ambiguous result appears high on the ranking list during an urgent offer.
• Acknowledge how you feel about the responsibility of interpreting data that directly impacts potential transplant offers.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as navigating and interpreting the data presented in ODT matching runs.
• Identify the specific insights you hope to gain into the logic and criteria used by the national matching algorithm for solid organ transplantation.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of reviewing complex data or transplant offers.
• Identify important information you need to consider before embarking on the activity, such as whether there are any bioinformatics tools or resources available to assist with interpreting the data.

 

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst interpreting information included on an ODT deceased donor solid organ matching run?
• Are you encountering situations such as:
  • An ambiguous HLA type or technical query appears high on the run list, complicating the rapid assessment of recipient suitability?
  • The urgency level dictates a shorter review time than anticipated, forcing a rapid adaptation of your systematic data checking process?
  • The matching run criteria appear to deviate from standard parameters for this specific organ type or patient sensitisation level, requiring immediate policy clarification?

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 data prioritisation or guideline adherence?
• Consider the steps you are taking in the moment, such as:
  • Immediately pausing interpretation to consult the specific ambiguity resolution guidelines for the HLA type identified
  • Instantly escalating the concern about the unexpected criteria or technical query to the supervising H&I Clinical Scientist for rapid clarification
• How are you feeling in that moment? For instance, did dealing with the urgency or ambiguity affect your ability to maintain focus? Is it affecting your confidence in making rapid, high-stakes decisions?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully interpreting the complex codes and making a rapid suitability decision? Or are you needing support because the technical error code cannot be resolved, necessitating the withdrawal of a potentially suitable recipient from consideration?
• What are you learning as a result of the unexpected development? For example, are you mastering the efficient application of complex national allocation algorithms under intense time pressure?

On action

What happened?

• Begin by summarising the key steps you took when interpreting the information on the specific ODT deceased donor solid organ matching run.
• Consider specific events, actions, or interactions which felt important, such as the types of information you focused on, such as donor and recipient HLA typing, antibody data, and matching scores, or the process of evaluating the potential matches.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, re-evaluating a match based on specific criteria or consulting with a supervisor.
• How did you feel during this experience, e.g., did you feel confident in your ability to practice effectively in partnership (LO 8) or stressed when faced with complex data or challenging matches?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding the interpretation of ODT matching runs. What strengths did you demonstrate, e.g., performing appropriate testing or practicing effectively in partnership?
• What skills and/or knowledge gaps were evident, e.g., gaps in your ability to interpret the data or assess matches?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in your skill in interpreting matching runs?
• Identify any challenges you experienced, such as complex compatibility issues or large lists of potential recipients, and how you reacted to this. Were you able to overcome them?

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 interpretation and reporting tests.
• What will you do differently next time you approach interpreting an ODT deceased donor solid organ matching run, for instance, by proactively studying specific matching algorithms or interpreting complex antibody profiles in the context of matching?
• Do you need to practise any aspect of the activity further, such as understanding specific matching algorithms or interpreting complex antibody profiles in the context of matching or key learning outcomes related to interpreting and reporting tests?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of interpreting ODT matching runs since completing this specific training activity led you to revisit your initial approach or decisions during that activity? The subsequent outcome of the donor offer or feedback on potential recipients may lead you to evaluate your initial interpretation process.
• Considering what you understand about speed of interpretation or understanding of specific codes/parameters on the run now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? You should review any actions for improvement you identified in previous reflections for this activity.
• How have you since implemented or adapted improvements in your speed of interpretation or understanding of specific codes/parameters on the run based on further learning and experiences? For example, improving your speed of interpretation or understanding of specific codes/parameters on the run forced you to re-evaluate the efficiency of your rapid data verification process during your first attempt at this training activity.
• Has discussing interpreting matching runs, the clinical urgency of interpreting them, or how different parameters impact the suitability of a donor or the impact of inappropriate planning on workflow with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity?

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent matching run interpretation experiences, contributed to your overall confidence and ability in rapidly and accurately interpreting complex information presented on an urgent deceased donor matching run, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated ability in understanding the priority system and the clinical relevance of different matches and mismatches now enables you to confidently participate in urgent allocation discussions during an OCE assessment.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to interpreting ODT matching runs?
• How does this evolved understanding help you identify when a matching run presents unusual information, involves complex patient/donor characteristics, or requires urgent clarification or expert interpretation, and when this is beyond your scope of practice?
• Looking holistically at your training journey, how has this initial matching run interpretation experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to rapid data analysis under pressure, application of complex algorithms/rules, critical evaluation of potential options, and understanding of an urgent clinical scenario? For example, how this foundational experience has supported your development in transferable skills such as rapid data analysis under pressure, application of complex algorithms/rules, critical evaluation of potential options, and understanding of an urgent clinical scenario.

Relevant learning outcomes

#	Outcome
# 1	Outcome Perform appropriate testing for potential deceased solid organ donors.
# 2	Outcome Interpret and report tests across the range of techniques applied and provide appropriate clinical advice for solid organ transplant.
# 3	Outcome Assess the suitability of patients for crossmatch and transplantation in deceased and live donor settings.
# 7	Outcome Practice in accordance with quality management and accreditation standards.
# 8	Outcome Practice effectively in partnership with service users, other clinical specialisms and the wider multidisciplinary team in the investigation of solid organ transplantation and platelet transfusion.