Module information

Module details

Title
Advanced H&I – Solid Organ Transplantation and Transfusion
Type
Specialist
Module code
S-HAI-S3
Credits
20
Phase
3
Requirement
Compulsory

Aim of this module

The aim of this module is to provide the trainee with the knowledge and skills relating to histocompatibility and immunogenetic testing applicable to solid organ transplantation and transfusion. This module will build on the Fundamentals of H&I module to provide experience and understanding of the clinical management of patients prior to and following organ transplantation. They will gain further experience in the methods that support transplantation and in the interpretation of patient results in a variety of complex clinical settings. This module will provide the trainee with the practical application of knowledge and skills relating to histocompatibility and immunogenetics techniques applicable to blood transfusion.

Work-based content

Competencies

# Learning outcome Competency Action
# 1 Learning outcome 2,3,7 Competency

Review antibody screening results for sensitised patients and define unacceptable antigens

Action View
# 2 Learning outcome 3,7 Competency

Assess and register patients onto the national deceased donor transplant list

Action View
# 3 Learning outcome 1,2,3,7,8 Competency

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

Action View
# 4 Learning outcome 2,3,7,8 Competency

Perform a virtual crossmatch assessment and prepare a report for a potential transplant recipient according to local policy

Action View
# 5 Learning outcome 1,7 Competency

HLA type a deceased potential donor according to local protocols

Action View
# 6 Learning outcome 1,2,7,8 Competency

Complete a deceased donor HLA report form for submission to NHSBT-ODT

Action View
# 7 Learning outcome 2,3,7 Competency

Select appropriate sera for highly sensitised patient crossmatching in accordance with local and national guidelines for a complex potential solid organ recipient case

Action View
# 8 Learning outcome 2,3,7,8 Competency

Under the supervision of an H&I Clinical Scientist or Consultant, prepare cross match reports for solid organ recipients with:

  • Standard
  • Intermediate
  • High-risk transplant scenarios
Action View
# 9 Learning outcome 2,3,7,8 Competency

Interpret testing results for a patient with an incompatible living kidney donor and outline the transplant options for the patient

Action View
# 10 Learning outcome 2,3,7,8 Competency

Select a sensitised patient and prepare an interpretive report for cardiothoracic transplant with a deceased donor offer

Action View
# 11 Learning outcome 2,4,7 Competency

Analyse test results for the detection or monitoring of donor specific antibodies for patients post transplantation

Action View
# 12 Learning outcome 2,4,7,8 Competency

Produce an interpretive report for a patient undergoing post-transplant antibody testing

Action View
# 13 Learning outcome 6,8 Competency

Present a case where a new or emerging technology or clinical intervention has been used for solid organ transplant

Action View
# 14 Learning outcome 2,5,7,8 Competency

Select a sensitised patient and prepare an interpretive report for clinical colleague for investigation of platelet refractoriness

Action View
# 15 Learning outcome 2,5,7 Competency

Select appropriate platelet units for patients requiring HLA/HPA selected platelets

Action View
# 16 Learning outcome 7 Competency

Review and interpret EQA report and critically evaluate results for antibody or cross match analysis

Action View
# 17 Learning outcome 7 Competency

Perform an audit in the laboratory and recommend corrective actions and service improvements

Action View
# 18 Learning outcome 6 Competency

Contribute to a service improvement project within your laboratory

Action View
# 19 Learning outcome 6 Competency

Attend a national meeting relevant to solid organ transplantation and provide feedback to your colleagues

Action View

Assessments

Complete 4 Case-Based Discussions

Complete 4 DOPS or OCEs

Direct Observation of Practical Skills Titles

  • Prepare a crossmatch report.
  • Analyse results of post-transplant monitoring.
  • Perform a virtual crossmatch for deceased or living donation.
  • Prepare a deceased donor ODT report.
  • Perform an immunological risk assessment for cardiothoracic donation according to UK guidelines.
  • Identify compatible HLA or HPA selected platelet units.
  • Interpret results of a UKLKSS matching run.

Observed Clinical Event Titles

  • Discuss a complex case on the transplant list with the multidisciplinary team to increase opportunities for transplant.
  • Present laboratory results for a solid organ transplant case at a multidisciplinary team meeting.
  • Request platelet increments data following clinical transfusion.
  • Take a patient history from another healthcare professional to inform interpretation of results for example sensitisation history.

Learning outcomes

# Learning outcome
1

Perform appropriate testing for potential deceased solid organ donors.

2

Interpret and report tests across the range of techniques applied and provide appropriate clinical advice for solid organ transplant.

3

Assess the suitability of patients for crossmatch and transplantation in deceased and live donor settings.

4

Perform clinical and laboratory monitoring of patients who have received a solid organ transplant.

5

Assess the suitability of patients for HLA/HPA selected platelets and identify compatible platelet units.

6

Appraise new and emerging technologies and clinical advances in the field of solid organ transplantation.

7

Practice in accordance with quality management and accreditation standards.

8

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.

Clinical experiences

Important information

Clinical experiences help you to develop insight into your practice and greater understanding of your specialty. Clinical experiences should be included in your training plan and you may be asked to help organise your experiences. While Clinical Experiences are not assessed, reflections and observations from your experiences can be used to support evidence for competencies to demonstrate your awareness and appreciation of your specialty and it’s impact on patient care. You may find it helpful to capture thoughts from your experiences in your reflective log.

Activities

  1. Visit another H&I laboratory to observe different practices or procedures which are not performed in your laboratory.
  2. Attend a living donor transplant.
  3. Shadow a transplant coordinator discussing transplantation with patients to appreciate their role and patient experience of transplantation.
  4. Attend a clinic where a Transplantation Surgeon is discussing the risk of transplantation with a patient to appreciate the patient experience.

Academic content (MSc in Clinical Science)

Important information

The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.

Learning outcomes

On successful completion of this module the trainee will be able to:

  1. Explain the relevance of HLA, HPA, HNA and other antigens in the use of a variety of blood products.
  2. Demonstrate a critical awareness of the adverse immunological events that can arise following transfusion of blood products and their investigation.
  3. Critically discuss the indications for platelet transfusion and the causes of platelet refractoriness.
  4. Describe the role of histocompatibility testing in pre-transplant work-up and post-transplant management of patients undergoing a variety of solid organ transplants.
  5. Critically appraise the novel forms of transplantation in development.
  6. Critically discuss and debate the ethical considerations associated with transplantation.

Indicative content

Transfusion:

  • Immunology of platelets and granulocytes.
  • Preparation of blood products for transfusion.
  • Development of HLA and non-HLA antibodies relevant to transfusion products.
  • Pathogenesis, investigation and risk reduction of transfusion-related adverse immunological events.
  • Indications for platelet transfusion.
  • Selection of platelet donors.
  • Causes of platelet refractoriness and use of increment data.
  • Indications for granulocyte transfusion.
  • Novel products (e.g. in vitro developed platelets).
  • Techniques for HPA and HNA screening and typing.
  • GMP standards/MHRA/BSQR (in relation to transfusion products).

Complex renal transplantation:

  • ABO incompatible.
  • HLA incompatible.
  • Non-HLA antibodies.
  • Highly sensitised patients.
  • Antibody titres and removal techniques.
  • UK living kidney sharing scheme.
  • Bioinformatics tools for donor selection in renal transplants.
  • Methods to improve organ quality.

Complications of solid organ transplants:

  • Post-transplant monitoring techniques.
  • Organ toxicities of immunosuppression.
  • Passenger lymphocyte syndrome.
  • Disease transmission.

Solid organ transplants:

  • National requirements for transplant patient testing and registration.
  • Liver.
  • Multivisceral.
  • Pancreas and islets.
  • Cardiothoracic (heart/lung).
  • Thymus.
  • Novel tissues and organs.

Tissue banking and other forms of graft:

  • Skin, cornea, heart valves, bone.

In vitro products:

  • Xenotransplants.
  • Novel grafts.
  • Mesenchymal stem cells.

Ethical considerations:

  • Implications of genetic testing.
  • Consent (opt-in vs. opt-out / Gillick competence / living donors).
  • HTA.
  • Tissue banking.
  • Allocation of organs.
  • Diseased organs.
  • Saviour siblings & pre-implantation genetic testing.
  • Novel xenografts and allografts.

Module assigned to

Specialties

Specialty code Specialty title Action
Specialty code SLS1-4-22 Specialty title Histocompatibility & Immunogenetics [2022] Action View